III.

mozardTa medicina

mozardobis cnebis gansazRvra. mozardebis anatomiur-

fiziologiuri da fsiqologiuri Taviseburebani

adamianis cxovrebis romel periods vuwodebT mozardobis asaks, ratom

gamovyofT mas calke periodad, ra aris am asakisaTvis damaxasiaTebeli? am
SekiTxvebs pasuxobs janmrTelobis dacvis saerTaSoriso organizaciis
eqspertebis mier 1974 wels SemuSavebuli gansazRvreba. am gansazRvrebis
Sesabamisad, mozardoba adamianis sicocxlis iseTi periodia, romlis dros
sruldeba sami Zalian mniSvnelovani procesi:
I- am asakSi iwyeba da mTavrdeba sqesobrivi momwifeba;
II- fsiqologiurad bavSvuri qceva icvleba zrdadasrulebuli adamianisaTvis
damaxasiaTebeli qceviT;
III- mozardis mozrdilebze socialurad da ekonomiurad damoukideblobis
periodi icvleba SedarebiTi damoukideblobiT.
am principebis gaTvaliswinebiT, 1977 w. jandacvis saerTaSoriso
organizaciis eqspertebis komitetma SeimuSava rekomendacia - mozardobis
asakad CaiTvalos adamianis sicocxlis periodi 10-dan 20 wlamde. am periodis
amgvari gamoyofa erTi SexedviT arabunebrivia, Zalian didia gansxvaveba 11
wlis bavSvsa da 19 wlis vaJkacs Soris _ da mainc, mozardobis aseTi gansazRvra
marTebulia, am periodis ganmavlobaSi bavSvi iqceva mozrdil adamianad. bevr
Zvel sazogadoebaSi bavSvobidan mozardobaSi gadasvlas sxvadasxva ritualiT
aRniSnavdnen. am ritualebis meSveobiT mozardi ara marto Rebulobda
garkveul sociologiur statuss, aramed, TiTqos xelmeored ibadeboda, Rebulobda
axal saxels. zogjer socialuri momwifeba ar Seesabameboda kalendarulad
sqesobriv momwifebas. aRsaniSnavia isic, rom jandacvis saerTaSoriso
organizaciis mier asakobrivi periodi 15 wlidan 24 wlamde atarebs
axalgazrdobis saxels. amrigad, adgili aqvs mozardobisa da axalgazrdobis
periodebis garkveul gadafarvas. saerTod am or periods bevri ram aqvs saerTo,
Tundac samedicino TvalsazrisiT, rac maTdami msgavs midgomas
ganapirobebs. saerTaSoriso dokumentebSi, magaliTad bavSvTa uflebaTa
deklaraciaSi bavSvobis asaki moicavs mozardobis did nawils, ganisazRvreba 18

1
wliT. yofil ssrk-Si arsebuli wesis Tanaxmad pediatriuli ambulatpriuli qseli
samedicino daxmarebas uwevda 15 wlamde asakis pirovnebas, Semdeg igi
mozrdilTa poliklinikas gadaecemoda.
mozardebSi zogjer 2 qveperiods gamoyofen: 1) pubertatobis anu
sqesobrivi momwifebisas (wlebi 10-dan 16 wlamde), iwyeba meoradi sqesobrivi
niSnebis gamomJRavnebiTa da ganviTarebiT da mTavrdeba reproduqciuli
fuqnciis Sesrulebis unaris CamoyalibebiT, romelsac mohyveba 2) socialuri
momwifebis qveperiodi. drois am monakveTSi adamiani irCevs profesias da
eufleba mas.
ufro miRebulia sami qveperiodis gamoyofa -
- adreuli (10-13 wlis gogonebi, 10-14 wlis vaJebi; saSualod 15 wlamde) -
mozardi mTlianad dakavebulia sakuTar sxeulSi mimdinare ZvrebiT. kritikuladaa
ganwyobili sakuTari garegnobis mimarT, fiqrobs mxolod sakuTar Tavze. am
periodSi Zalian maRalia fizikuri aqtivobis done da aRiniSneba guneba-
ganwyobis mkveTri meryeoba.
- Sualeduri (14-16 wlis gogonebi, 15-17 wlis vaJebi; saSualod 15-dan 18
wlamde, e.w. mozrdilTa kabinetebis kontingenti) - umTavresi sazrunavi
damoukideblobis mopovebaa. Tanatolebis wre gansazRvravs socialuri
cxovrebis stils. dominirebs riskTan dakavSirebuli qceva. sqesobrivi sakiTxebis
mimarT interesi kulminacias aRwevs.
- gviani (18 wlis zemoT) mozardi mozrdilobis xanas uaxlovdeba. TiTqmis
Camoyalibebulia momavlis gegmebi, gansazRvrulia orientacia, kargad
xerxdeba Sinagani kontroli. miuxedavad amisa, mozardebis umetesobas kidev
bevri gaurkveveli sakiTxi rCeba sqesobrivi sferos, momavali urTierTobebisa da
karieris TvalsazrisiT.
socialuri momwifebis asakze msjelobisas, bevri mis ZiriTad maxasiaTebel
kriteriumad miiCnevs SromiTi saqmianobis dasawyiss. eseni ZiriTadad soflisa
da qalaqis muSa axalgazrdobaa, studentebi ki am TvalsazrisiT maT
CamorCebian, isini mSoblebze damokidebulebis statuss ufro didxans
inarCuneben.
socialuri momwifeba araerTi faqtoriT ganisazRvreba:
 SromiTi saqmianobis dawyeba;
 ekonomiuri damoukidebloba;
 politikuri da moqalaqeobrivi srulwlovaneba;
 samxedro samsaxuri;
2
  qorwineba;
 pirveli bavSvis gaCena.
socialuri momwifebis sferoSi, iseve rogorc pubertatobis wlebSi,
axalgazrdebis sxvadasxva jgufs Soris Zalian didi gansxvavebulobaa;
axalgazrda, romelic momwifebulia SromiTi saqmianobisaTvis da eweva kidec
mas, SeiZleba mozardad rCebodes gogonebTan urTierTobaSi, kulturuli
moTxovnilebebis sferoSi da piriqiT.
mozardobis asaks gardamavalsac uwodeben, bavSvobidan mozrdilobaSi
gadasvla Zalze xSirad kritikul elfers iRebs; ramdenad mkveTri da
yovlismomcvelia cvlilebebi pirovnebaSi? fsiqikuri Tvisebebi sxvadasxvanairad
icvleba - erTni swrafad, meoreni ki Znelad, an rCebian SedarebiT ucvlelebi
mTeli cxovrebis manZilze. zogierTi mozardisaTvis misi cxovrebis es xana
mimdinareobs duned da mdored, meorisaTvis ki areulad, mtkivneulad. es
damokidebulia, rogorc garemosa da aRzrdaze, ise organizmis memkvidrul
Tvisebebze. gasaTvaliswinebelia, rom mozardTa asakSi fiziologiuri normebi
Zalian variabeluria da isini xSirad SeiZleba avadmyofur gamovlinebad
CavTvaloT. ar aris advili premorbiduli simptomebis avadmyofobaSi gadasvlis
dadastureba. eqimis erT-erTi amocana aseTi transformaciis profilaqtikaa.
mozardisTvis damaxasiaTebelia gazrdili interesi sakuTari Tavis mimarT.
igi mudam adarebs Tavis Tavs, Tavis saqciels Tanatolebis, aseve mozrdilebis
qcevasTan. igi cdilobs gamoimuSaos sakuTar TavSi iseTi Tvisebebi, romlebic
daexmareba mas warmatebis miRwevasa da sxvebTan urTierTobis
gaadvilebaSi. mozards sociumSi eZleva SesaZlebloba warmoadginos sakuTari
Tavi, daimkvidros Tavi sazogadoebaSi da srulyofas miaRwios. samyaro
mozardisaTvis mniSvnelovan wilad mozrdili adamianis meSveobiT aRiqmeba.
mozardi maTgan gagebasa da ndobas moelis. Tu am miswrafebebze mozardi
tyuvdeba, cdeba, mas sapasuxod gamoumuSavdeba protestis sxvadasxva
formebi-uxeSoa, negativizmi, sijiute, Tavis TavSi Caketva, agresiuloba. es
Tvisebebi da niSnebi ar aris mozardebisaTvis aucileblad damaxasiaTebeli, isini
uxSiresad mozardis mimarT araswori midgomis, araswori aRzrdis Sedegebia.
mozardi iswrafis, rom igi srulfasovan pirovnebad CaTvalon, gaiTvaliswinon misi
miswrafebebi. samwuxarod, saskolo da saojaxo praqtikaSi xSiria aseTi
midgoma: mozardi bavSvia, igi unda emorCilebodes ufrosTa moTxovnebs.
mozards pirdapir eubnebian: `nu gvibruneb enas, gaakeTe, rasac geubnebian,
roca gaizrdebi, maSin SegiZlia idavo.~
3
 mcdaria Sexeduleba, TiTqos mozards ar SeuZlia damoukideblad
iniciativis gamovlena. zogierT ojaxSi mozardTa damoukidebloba metad pirobiTi
mcnebaa. mSoblebi, Tumca ki cdiloben Caaban mozardi SromiT saqmianobaSi,
sruliad ar iTvaliswineben mis survilebs, mis moTxovnilebebs. mSoblebs,
romlebic ar icnoben bavSvTa fsiqologias, hgoniT, rom mozardad gadaqceuli
bavSvis fsiqologiaSi araferi Secvlila. misi warmateba-warumatebloba swavlaSi
kvlav is ZiriTadi kriteriumebia, romlebiTac ufrosebi afaseben mas. swavla,
rogori mniSvnelovanic ar unda iyos is, ver akmayofilebs mTlianad bavSvis
interesebs, mis mzard moTxovnilebebs, sazogadoebrivad mniSvnelovani
moqmedebis survils. swavlasTan erTad mozardisaTvis Zalze mniSvnelovania
sporti, teqnikuri da mxatvruli Semoqmedeba, sazogadoebrivi aqtivoba, misi
pozicia TanatolTa koleqtivSi da bevri sxva ram.
mozardobis periodSi xdeba pirovnebis Camoyalibeba, genetikuri Cadebuli
programis realizacia, garkveuli konstituciuri tipis Camoyalibeba. am asakSi
momwifebas ganicdis organizmis morfologiuri da funqciuri sistemebi, yalibdeba
reproduqciuli sistema, formirdeba seqsualuri qcevis tipi. aRniSnulTan
dakavSirebiT TandaTanobiT wina planze gamodis reprouqciuli janmrTelobis
problemebi. mozardobis ZiriTadi maxasiaTebelia is, rom organizmSi manamde
SedarebiT dinjad mimdinare fiziologiuri da fsiqologiuri procesebi aqtiurdeba,
energiulad gardaiqmneba endokrinuli sistema, organizmis yvela funqcia
intensiur, gacxovelebul muSaobas iwyebs. aRwerili mdgomareoba ganixileba,
rogorc bunebrivi funqciuri datvirTva. mozardobis dros organizmSi mimdinare
procesebi simZafriT sWarbobs bavSvobaSi mimdinare procesebs. isini am
TvalsazrisiT II adgilzea axalSobilobis asakis Semdeg. organoebi da organoTa
sistemebi heteroqronulad viTardeba. xSiria calkeuli individumebis saerTo
normaluri standartebidan (morfologiuri, funqciuri, fsiqikuri) mniSvnelovani
gadaxrebi. es faqti aucilebel pirobad ayenebs fiziologiuri normebis
SemuSavebis aucileblobas. mozardTa asakSi Zalian gavrcelebulia
paTologiasTan mosazRvre somaturi da fsiqikuri mdgomareobebi. yalibdeba
fsiqologiurad specifikuri Taviseburebebi, qcevis stereotipebi, rac daRs asvams
pirovnebas da xSirad gayveba mas damaxasiaTebel Taviseburebad Semdgom
cxovrebaSi. mozardTa did umravlesobas uyalibdeba qcevis tipi, romelic
ancvifrebs axloblebs, pedagogebs, eqimebs. mozardebs uCndebaT
gankerZoebisadmi, calkeul jgufebad Sekvris midrekileba, hiperseqsualoba.

4
aRniSnuli qcevis Taviseburebebi araiSviaTad am asakis pirovnebebis saqciels
asocialurobis niSan-Tvisebebs aniWebs.
amgvarad, mozardobis asaki aris adamianis sicocxlis realuri periodi 10-
dan 20 wlamde. am asakSi adamiani ukve aRar aris bavSvi, emgram jer kidev
ar aris mozrdili. specialistebis mtkicebiT, mozardebs ergebaT yvelaferi cudi
bavSvobisagan da mozrdilobisagan - maT jer kidev ara aqvT mozrdilTa
uflebebi, amave dros isini ukve aRar iReben im siTbosa da mzrunvelobas
mSoblebisagan, rasac bavSvebi.
mozardobis asakSi adgili aqvs organizmis zrda-ganviTarebis mkveTr
daCqarebas. zrda cocxali materiis zogadi biologiuri Tvisebaa. zrda gamoixateba
organizmis masisa da zedapiris matebaSi. zrdis raodenobrivi procesis
paralerulad mimdinareobs ganviTarebac. ganviTareba Tvisobriv cvlilebebs
gulisxmobs, gulisxmobs qsovilebisa da organoebis diferenciacias. amave dros
mimdiareobs organizmis funqciuri sistemebis srulyofa, maTi momzadeba
imisaTvis, rom optimalurad Seasrulos is funqciebi, romlisTvisac arian
mowodebulni.
dRes mozardTa zrda-ganviTarebis tempebi gacilebiT ufro maRalia, vidre
erTi saukunis win. es dakavSirebulia cxovrebis pirobebis gaumjobesebasTan,
ukeTes kvebasTan, radiaciis momatebasTan, jandacvis gaumjobesebasTan da,
SesaZloa, sxva jerac ucnob faqtorebTan. am movlenas aqceleracias uwodeben.
am dros aRiniSneba anTropometriuli monacemebis (wona, simaRle, gulmkerdis
garSemoweriloba da sxva) mkveTri mateba, swrafi sqesobrivi momwifeba.
Semdgom aqseleraciis procesebi sustdeba, Tumca rigi problemebisa, rac man
gamoiwvia, rCeba. pubertatobis periodSi organoebisa da organoTa sistemebis
zrda-ganviTarebis intensifikaciis uaryofiTi momenti is aris, rom am dros
SesaZlebelia organizmis ama Tu im sistemis `sisustis~ Camoyalibeba; ase
magaliTad, safuZveli eyreba mxedvelobis problemebs, arteriul hipertenzias,
sayrdeni aparatis paTologias. erT-erTi uaryofiTi Sedegia daavadebebis
mniSvnelovani gaaxalgazrdaveba.
mozardobis erT-erTi mTavari morfologiuri Taviseburebaa simaRleSi
mkveTri zrda - e.w. zrdis pubertatuli naxtomi (spurti). gogonebSi igi iwyeba
daaxloebiT 11-12 wlis asakSi, biWebSi 1 wliT gvian. gogonebSi amas Tan sdevs,
rogorc wesi, pirveli menstruacia (menarqe), zogjer piriqiTac xdeba. pubertatul
periodSi ZiriTadad sruldeba sqesobrivi dimorfizmis tipologiuri niSnebis
Camoyalibeba.
5
 pubertatuli periodis dasawyisSi intensiurad izrdeba qvemo kidurebi.
Tanmimdevroba aseTia - terfi, wvivi, barZayi. gogonebSi intensiurad izrdeba
menji - matulobs manZili TeZos Zvlebs qedebs Soris. mogvianebiT intensiur
zrdaSi CaerTveba zemo kidurebic. aseTi TanmimdevrobiT majebi, winamxrebi,
mxrebi. marTalia, zemo kiduris zrda majidan iwyeba, magram yvelaze
intensiurad izrdeba mxari. qvemo kidurebs zrda gogonebSi ufro adre neldeba,
amitomac tanis Sefardeba qvemo kidurebTan gogonebSi metia, vidre biWebSi.
10 wlis bavSvis Tavis qala sididiT mozrdilis 90-95%-is tolia, amitom
pubertatobis periodSi igi naklebi intensivobiT izrdeba, magram SesamCnevad
icvleba proporciebi sxavadsxva nawils Soris. zrdis pubertatuli naxtomidan 1
Tvis Semdeg aqtiurad iwyebs zrdas (gansakuTrebiT biWebSi) qveda yba,
Semdeg zeda yba da cxviri. izrdeba Tvalbudeebis sagitaluri da horizontaluri
zedapirebi, ramac SeiZleba biZgi misces miopiis ganviTarebas.
pubertatul periodSi mkveTrad vlindeba individualuri gansxvavebebi
fizikur da sqesobriv ganviTarebaSi, mozardebi, romleic CamorCebian fizikur
zrdaSi da ganviTarebaSi, xSirad CamorCebian aseve Sromisunarianobasa da
swavlis unariT.
zrda da ganviTareba pubertatul periodSi heteroqroniis principebis
safuZvelze xdeba - e.i. araTanabrad, disproporciulad. ufro swrafad viTardeba
Zvlebi, kunTebi, periferiuli nervebi, naklebi intensivobiT Tavis qalas Zvlebi,
Tavi, tvini. heteroqroniis gamo organizmis SesaZleblobebi sxvadasxvanairi
datvirTvis mimarT araTanabaria: ase magaliTad, organizmi mgrZnobiarea
Jangbadis naklebobisadmi, naklebad amtania swraf sirbilSi, masSi ufro
xangrZlivad xdeba Zalebis aRdgena maqsimaluri siswrafiT curvis Semdeg.
mozardebSi mniSvnelovania biologiuri asakis dadgena. imitom, rom
organizmis somato- da fiziometruli monacemebi Seesabameba mis individualur
maxasiaTeblebs da ara kalendarul asaks.
organizmis fizikuri da fsiqologiuri ganviTareba arsebul garemoSi masSi
Cadebuli Tvisebebisa da unaris realizaciis Sedegia. garemos ra faqtorebis
axdenen zegavlenas organizmis zrda-ganviTarebaze-uwyoben xels an
aferxeben mas? esenia: aRzrda (fsiqologiuri garemo), kveba, fizikuri aqtivoba,
kulturuli garemo, mecadineoba, urbanizacia, ekologia, somaturi daavadebebi.
Sinagan faqtorTagan gadamwyvetia genotipi, e.i. im genebis erToba,
romlebic Cadebulia organmizmSi da ganapirobebs am individumis konstitucias.

6
 organizmis fizikuri ganviTareba misi saerTo ganviTarebisa da
janmrTelobis erT-erTi maxasiaTebelia. amitom aucilebelia organizmis fizikuri
monacemebis yovelwliuri Seswavla.
fizikuri ganviTarebis daxasiaTeba sam Semadgenels moicavs:
 fizikuri ganviTarebis done
 somatotipi (sxeulis sami ZiriTadi zomis Tanafardoba)
 gulis totaluri zomebis matebis intensivoba
fizikuri ganviTarebis erT-erTi ZiriTadi maCvenebeli sxeulis sigrZea. misi
mateba da saboloo sidide genetikuradaa determinirebulia. genetikuri
programis realizaciis yvelaze mgrZnobiare periodi 4-dan 12 wlamdea.
fizikuri ganviTarebis donisa da dinamikis mniSvnelovania maCvenebelia,
agreTve, sxeulis absoluturi da SefardebiTi (masis 1kg-ze) farTi. fizikuri
ganviTarebis kargi ganviTarebis kargi dinamikis maCvenebelia sxeulis
absolituri zedapiris farTis mateba da SefardebiTis kleba.
11 wlis asakidan gogonebSi, xolo 12 wlis asakidan biWebSi sxeulis masis
matebis tempi uswrebs sigrZis matebis temps. Zvlebis, kunTebis, RviZlis,
elenTisa da Tirkmlebis zrdis tempebi ZiriTadad imeorebs mTeli sxeulis zrdis
tempebs, rac Seexeba Tavis tvins, limfur jirkvlebs, reproduqciul organoebs,
kanqveSa qsovils, reproduqciul organoebs, maTi zrdis tempebi sxvaa. Tu ufrosi
asakis bavSvi ar matulobs simaRlesa da wonaSi, saWiroa srulyofili samedicino
gamokvleva.
zrdaSi SeiniSneba sqesobrivi gansxvavebebi. gogonebSi intensiuri zrda
10 1/2 wlis asakSi iwyeba, aRwevs maqsimums 12-13 wlis asakSi da
mTavrdeba 19 wlisaTvis, biWebSi iwyeba intensiuri zrda iwyeba 14 ½ wlis
asakSi, maqsimaluria 14-dan 17 wlamde da mTavrdeba 20 wlisaTvis. 18 wlis
asakSi gogonebis 99% -Tvis simaRleSi zrda dasrulebulia, vaJebSi ki SeiZleba
kidev gagrZeldes weliwadSi ori sm-iT. sxeulis masis intensiuri zrda simaRleSi
intensiur zrdas daaxloebiT 6 TviT CamorCeba.
pubertatuli periodis dawyebamde zrdis tempebs ganapirobebs farisebri
jirkvlis hormonebi, insulini da somatotropini. maSasadame, zrdis procesis
darRveva nebismieri maTganis naklebobam (an siWarbem) SeiZleba
gamoiwvios.
sqesobrivi ganviTareba. pubertatuli periodis dawyeba dakavSirebulia
sasqeso jirkvlebze - saTesle jirkvlebsa da sakvercxeebze - gonadotropinis
zemoqmedebasTan. gonadotropuli hormonebi (maluTeinizirebeli da
7
folikulmastimulirebeli) gamomuSavdeba hipofizSi, masze gonadotropin-rilizing-
hormonis moqmedebis sapasuxod. es ukanaskneli hipoTalamusSi
gamomuSavdeba. gonadotropuli hormonebis moqmedebiT biWebis saTesle
jirkvlebSi gamomuSavdeba testosteroni. pubertatuli periodis dawyebamde igi
umniSvnelo raodenobiT gamomuSavdeba, rogorc biWebSi, ise gogonebSi. 13-
15 wlis asakSi misi gamomuSaveba mniSvnelovnad matulobs da es iwvevs
kerZod, gogonebSi, boqvenis gaTmianebas. biWebSi ki sworad testosteroni da
dihidroergosteroni arian is ZiriTadi sasqeso hormonebi, romlebic
ganapirobeben biWebSi reproduqciuli sistemis ganviTarebas (meoradi sasqeso
niSnebis ganviTareba da reproduqciis funqcia). gogonebSi ZiriTadi sasqeso
hormonia 17-estradioli. igi ganapirobebs qalis sasqeso sistemis srulyofil
ganviTarebas.
sasqeso niSnebis ganviTarebaSi monawileobs agreTve Tirkmelzeda jirkvlis
qerqi, romlis hormonebi androgenebis msgavs rols asruleben meoradi sasqeso
niSnebis ganviTarebaSi.
sasqeso simwifis gansazRvra xdeba meoradi sasqeso niSnebisa da sasqeso
organoebis mixedviT. sqesobrivi ganviTarebis formula sakmaod martivia da
myaria mTeli pubertatuli periodis manZilze. igi Seesabameba biWebis
kalendarul asaks 12-16 ww da gogonebis 10-15 ww. am formulis gamoyeneba
Zalze aadvilebs muSaobas da mozardebis zrda-ganviTarebis xarisxis
Sefasebas. igi emyareba meoradi sasqeso niSnebis Sefasebas.
sqesobrivi ganviTarebis formulaSi gamoiyeneba Semdegi Semoklebebi:

P, Ax, boqvenis, iRliebisa da saxis Tmianoba

FF
C farisebri xrtilis ganviTareba, xorxis Senebis cvlilebebi
V xmis mutacia
Ma sarZeve jirkvlebis zrda
Me menstruaciis gamoCena da ovariul-menstrualuri ciklis
Camoyalibeba

gogonebisa da biWebis sqesobrivi ganviTarebis stadiebi (taneri, 1979)

stadiebi gogonebi biWebi

8
 sarZeve jirkvlebi penisi, saTesle jirkvlebi, saTesle
ganuviTarebelia, dvrilebi jirkvlebis parki-bavSvuri
wamoweuli
I
boqvenis Tmianoba ganuviTarebelia

sarZeve jirkvlebi iwyebs saTesle jirkvlebi da saTesle

Sevsebas, viTardeba areolebi jirkvlebis parki iwyebs
II ganviTarebas, misi kani wiTldeba
iSviaTi, grZeli, sustad pigmentirebuli Tmis Rerebi

sarZeve jirkvlebi da areolebi saTesle jirkvlebi, parki da penisi

agrZeleben zrdas agrZelebs zrdas
III
Tma muqdeba, uxeSdeba, iwyebs zrdas boqvenis zemoTac

IV areola da dvrilebi wamoweulia saTesle jirkvlebis, parkis zrdis

sarZeve jirkvlis konturis zemoT. gagrZeleba, penisi izrdeba
Tmianoba qaluri tipiT, magram diametrSi, Tmianoba mamakacuri
ara mTels boqvenze tipiT, magram ara mTels boqvenze
V sarZeve jirkvlebi-rogorc qalebs, garegani genitaliebi-rogorc mozr-
areola ar aros wamoweuli dils
sarZeve jirkvlis konturze
Tma mTel boqvens faravs

meoradi sasqeso niSnebi Sefaseba vaJebSi

Ax 0, P Tmebis ararseboba boqvenze da iRliebis qveS

0
Ax 1, P erTeuli Tmebi
1
Ax 2, P erTeuli Tmebi patara ubanze
2
Ax 3, P Tmebi sworia, ikavebs mTels iRliis fosos da araTanabarad arian
3 ganviTarebuli mTels boqvenze
Ax 4, P xSiri xveuli Tmebi, izrdebian Wipiskenac da barZayebis SigniTa
4 zedapirze
Ax 5, P xSiri xveuli Tmebi mTels iRliis fosoSi da boqvenze samkuTxedis
5 saxiT
F0 saxeze Tmis ararseboba
F 1F RinRli zeda tuCze
F 2F erTeuli Tmebi nikapze
C0 farisebri xrtilis zrda ar dawyebia
C1 farisebri jirkvali ar Cans, magram isinjeba kisris palpaciisas
C2 farisebri xrtili Cans TvaliT
V0 bavSvuri xma
V1 xmis mutacia
V2 mamakacuri xma

meoradi sasqeso niSnebis ganviTarebis Tanmimdevroba sxvadasxva

literaturuli wyaros mixedviT aseTia:
 saTesle jirkvlebis gadidebis dawyeba 11-12 ww

9
  boqvenis gaTmianebis dawyeba-12-13 ww
 asos mniSvnelovani zrdis dawyeba-12-13 ww
 xmis mutacia-13-14 ww
 iRliisqveSa gaTmianeba-14 w
 poluciebi-14-15 ww
 saxis gaTmianebis dawyeba 14-16 ww

meoradi sasqeso niSnebis Sefaseba gogonebSi

Ax 0, P Tmis ararseboba boqvenze da iRliebis qveS

0
Ax 1, P erTeuli Tmis Rerebi
1
Ax 2, P iSviaTi pirdapiri Tmebi boqvenis SuaSi da iRliebSi
2
Ax 3, P xSiri xveuli Tmebi boqvenis samkuTxedze da iRliebSi
3
Ax 4, P Tmianoba mozrdilTa tipiT
4
Me 0M menstruaciis ararseboba
Me 1M Camouyalibebeli menstruaciis tipi
Me 2 regularuli menstruaciebi
Ma 0 sarZeve jirkvlebi ar gamoikveTeba mkerdidan
Ma 1 areola dvrilTan erTad qmnis erTian konuss, romelic gamodis
mkerdis zedapiridan
Ma 2 areola didi zomis, dvrili ar aris didi, jirkvli gadidebulia
Semofarglulad (kokris stadia)
Ma 3 sarZeve jirkvlis sruli ganviTareba, magram dvrili ar diferencirdeba
areolisagan
Ma 4 mozrdili qalis mkerdi, dvrili maRldeba areolaze

gogonebSi pubertatuli momwifebis Tanmimdevroba -

- areolis hiperemia da pigmentacia, menjis Zvlebis zrda-9-10ww;
- sarZeve jirkvlebis zrda (telarxe) da boqvenis gaTmianebis (pubarxe)
dawyeba-10-11 ww;
- Sinagani da garegani genitaliebis zrda, sarZeve jirkvlebis Semdgomi zrda,
iRliebis gaTmianebis dawyeba-10-12 ww
- dvrilebis pigmentacia, menstruaciis gamoCena-12-13 ww
- ovulacia –13-14 ww;
- xmis tembris daqveiTeba, Aakne vulgaris-14-15 ww
miTiTebuli vadebi pirobiTia, dasaSvebia gadaxrebi. saWiroebis
SemTxvevaSi SeiZleba orientireba mSoblebis sqesobrivi momwifebis vadebze.
individumis fiziologiuri asakis kalendarulTan Sesabamisobis dadgenis
xarisxis dasadgenad mowodebulia cneba fiziologiuri momwifeba. pubertatuli

10
asakis mniSvnelovani Taviseburebaa biologiuri da kalendaruli asakis xSirad
araTanxvedra. saintereso da mniSvnelovania, rom am periodis pirvel
naxevarSi, gansakuTrebiT gogonebSi, biologiuri asaki ufro xSirad win uswrebs,
ufro iSviaTad ki CamorCeba kalendaruls. am SemTxvevaSi aucileblad unda
dadgindes, eteva Tu ara SeniSnuli gansxvavebebi normiT gaTvaliswinebul
CarCoebSi, Tu adgili aqvs Seusabamobas normalur farglebTan. samwuxarod,
dasaxelebuli faqti yovelTvis ar fasdeba saTanado yuradRebiT specialistebis
mier.
mSoblebi da pedagogebi, rogorc wesi, bavSvTan mimarTebaSi msjeloben
kalendaruli asakis mixedviT, magram gadamwyveti swored biologiuri
maxasiaTeblebia. Tu vlindeba Seusabamoba biologiur da kalendarul asaks
Soris, bavSvs eqmneba problemebi (fsiqologiuri, socialuri), rac damatebiTi
nevrotizaciis winapirobaa.
mozard gogonebSi SeiZleba garkveuli daZabulobac Seiqmnas
urTierTobebSi imis gamo, rom mag. 12 wlis gogonebi SeiZleba erTmaneTisagan
gansxvavdebodnen ara marto woniTa da simaRliT, aramed sqesobrivi
momwifebis stadiebiTac ki. swored am faqtis gaTvaliswinebiT unda miudgnen
maT mSoblebi da pedagogebi. fiziologiuri mowifulobis gansazRvrisaTvis
erTmaneTs usadageben biologiur asaksa da kalendarul asakis tipobriv
maxasiaTeblebs. arsebobs biologiuri mowifulobis Sefasebis sami meTodi -
1)kbilebis raodenobis mixedviT. es meTodika efeqturia 6-dan 13 wlamde.

mudmivi kbilebis saSualo raodenoba (Mm)

asaki kbilebis raodenoba

gogonebi biWebi
10 18,53,5 17,53,5
11 21,03,0 20,04,0
12 25,03,0 24,03,0

2) ConCxis mixedviT-marjvena xelis mtevnisa da majis Zvlebis

rentgenogramebiT. es meTodi moqmedia 7-dan 18 wlamde.

gaZvalebis vadebi

11
 gaZvalebis wertilebi da sinostozebi gaZvalebis saSualo asaki
gogonebi biWebi
muxudosebri Zvali 8,5-9,0 11,0-12,0
mtevan-falangis pirveli sesamoiduri 11,0-11,5 13,5-14,0
Zvlebi
mtevnis Zvlis sinostozi 12,5-13,0 15,5-16,0
distaluri falangebis sinostozebi 13,5-14,0 16,0-16,5
ZiriTadi falangebis sinostozebi 15,5-16,0 16,5-17,0
saSualo falangebis sinostozebi 15,5-16,0 16,5-17,0
II-V mtevnis Zvlebis sinostozebi ~~ ~~
idayvis Zvlis distaluri epifizis sinostozi ~~ ~~
sxivis Zvlis distaluri epifizis sinostozi 16,5-17,5 18,0-19,0

3) sqesobrivi momwifebis formuliT.

organizmis funqciuri sistemebis ganviTareba. hematoencefaluri

barieri pubertatobis periodSi arasrulfasovania da SeRwevadia bevri
toqsinisaTvis. amiT SeiZleba aixsnas am periodSi vegetodistoniebis siWarbe.
cns advilad agznebadia. mozardebis qceva amis gamo xSirad araadekvaturia.
qerqisa da qerqqveSa struqturebis disbalansi aqveiTebs cns-is adaptaciur
SesaZleblobebs.
11-16 ww eeg-ze xSiria -riTmis hipersinqronizacia, misi gaiSviaTeba da
neli rxevebis gamoxatva. eeg definitur xasiaTs iRebs 16-18 wlis asakSi.
pubertatul asakSi ikveTeba nervuli sistemis-simpaTikuri da
parasimpaTikuri nawilebis funqcionireba. maRali simpaTikuri aqtivoba saWiroa
procesebis energiiT mosamarageblad, parasimpaTikuri-anaboluri procesebis
aqtivobisaTvis. amitom, vegetodistoniis elementebis gamoxatuleba mozardebSi
TiTqmis normaa.
SemaerTebeli qsovili faSari da nazia. advilad viTardeba myesebis sisuste-
saxsrebis hipermobiluroba, tanadobis darRvevebi, brtyelterfianoba, miopia,
visceroptozi. SemaerTebeli qsovili mgrZnobiarea infeqciebisadmi. amitom
praqtikulad nebismieri infeqciuri procesi SeiZleba garTuldes arTralgiebiTa da
reaqtiuli arTritebiTac ki.
pubertatuli periodis dasawyisSi izrdeba ZiriTadad grZeli, lulovani Zvlebi,
rac ganpirobebulia somatotropoli hormonis zemoqmedebiT. mxris sartylisa da
menjis Zvlebi iwyeben intensiur zrdas (sasqeso hormonebis moqmedebis
efeqti), mogvianebiT, igive iTqmis kunTebzec. amitom, pubertatobis
dasawyisSi Zvlebis simtkice ar aris srulyofili.
12 wlisaTvis kunTebis sainervacio aparatis momwifeba, ZiriTadad
mTavrdeba, magram sayrden mamoZravebeli aparatis ganviTareba jer kidev
12
dasrulebuli ar aris. aRnagoba harmoniuli xdeba 14-15 wlisaTvis, rodesac
kunTebi sakmao Zalas iZenen da SeimCneva ZalaSi sqesobrivi gansxvavebebi.
16-18 wlis asakSi WabukebSi Zvlebis ganviTareba grZeldeba, xolo gogonebSi
ukve dasrulebulia. Zvlebis ganviTareba sqesobrivi simwifis saimedo
maCvenebelia. Zvlebis epifizuri napralebis daxurva Zvlebis ganviTarebis
damTavrebis maCvenebelia. 14-15 wlis asakSi gogonebSi Zalian gazrdilia
kalciumis moTxovnileba, am dros maTTvis Zalian sasargebloa rZisa da xaWos
miReba. anoreqsia da Sedegad araadekvaturi kveba Zalze uaryofiTad
moqmedebs Zvlebze da xels uwyobs osteoporozis ganviTarebas (es
gansakuTrebiT aqtualuria seniluri osteoporozisa da misi umZimesi garTulebis -
barZayis yelis motexilobis profilaqtikisaTvis).
Zvlis ganviTarebaze dadebiTad moqmedebs fizikuri datvirTva, magram
zomierad. yovel SemTxvevaSi, gadaWarbebuli fizikuri datvirTvisas, amenoreas
rom iwvevdes, mozardi gogonas Zvlebis struqtura uaxlovdeba 50 wlis qalisas.
Zvlovani sistemis ganviTarebaze uaryofiTad moqmedebs dishormonuli
situaciebi, gamowveuli hipoTalamuri sindromiT, Tambaqos weva, alkoholi.
pubertatuli periodis bolos gogonebis simaRle 10-12 sm-iT naklebia
biWebisas, wona 5-8 kg-iT (CvenSi). gogonebis tani SedarebiT grZelia, fexebi
ufro mokle, gulmkerdi ki ufro moklea da farTo, vidre biWebSi.
mozardebSi gul-sisxlZarRvTa sistemis Taviseburebebi sakmarisad
gamokveTilia. korelacia sxeulisa da gulis zomebs Soris myaria. amasTan erTad
mozardebisaTvis damaxasiaTebelia gulis zomebis zrdis upiratesoba
sisxlZarRvebis sanaTuris zrdasTan SedarebiT. es erT-erTi faqtoria, romelic xels
uwyobs mozardebSi arteriuli hipertenziisa da sistoluri Suilis xSir ganviTarebas.
am asakSi xSiria gulis riTmis darRvevebisa. 19-20 wlis asakisaTvis gul-
sisxlZarRvTa sistemis morfo-funqcionaluri parametrebi aRwevs ufrosebis
parametrebs.
mozardebSi aSkaraa am sistemis funqcionirebaSi sqesobrivi
gansxvavebebi-biWebis gulis wuTmoculoba, adaptacia fizikuri datvirTvisadmi
ukeTesia, vidre gogonebSi.
mozardTa ganviTarebis 6,5% SemTxvevaSi xdeba gul-sisxlZarRvTa
sistemis ganviTarebis gadaxra hipo-an hiperevoluciis mimarTulebiT. I varianti
moicavs gulis saerTo hipoevoluciur mdgomareobas an hipoevoluciur mitralur
guls, II varianti ki gulis Wabukur hipertrofias.

13
 saerTo hipoevoluciuri mdgomareoba xSiria zogadad asTeniur
axalgazrdebSi da xasiaTdeba gulis mcire zomebiT. am mdgomareobas xels
uwyoben infeqciebi, arasrulfasovani kveba, hipodinamia, qronikuli gadaRliloba.
mitraluri hipoevoluciuri guli aqvT iseT axalgazrdebs, romlebSic gulis
Semobruneba win da marcxniv ar Sesrulda. amitom, Tumca am axalgazrdebSi
gulis zomebi normaluria, frontalur rentgenogramaze mas mitraluri konfiguracia
aqvs (gulis ~taliis~ midamoSi filtvis arteriis gamodrekilobis gamo). aseTi
axalgazrdebi arafers uCivian, magram aseTi guli mainc iTvleba normis
variantad.
gulis Wabukuri hipertrofia xSiria im mozardebSi, romlebic harmoniulad
viTardebian, ewevian sports. aseTi gulis funqcionaluri mdgomareobis
maCveneblebi kargia.
mozarTa asakSi, upiratesad aranavarjiSeb axalgazrdebSi, gulis
wuTmoculobis maCveneblebi xSirad Zalian mniSvnelovnad aWarbebs saWiro
maCveneblebs. es gul-sisxlZarRvTa sistemis araekonomiuri funqcionirebis, misi
dabali adaptaciuri SesaZleblobebis winapirobaa. safuZvelia. janmrTel
mozardebSi hemodinamikis tipi 50-60%-Si eukinetikuria (gulis indeqsi 3,1-
3,9l/wT/m2-ia biWebSi da gogonebSi 2,6-3,5 l/wT/m2).
gulisa da msxvili sisxlZarRvebis inspeqciisas xSirad TvalSisacemia gulis
saZgeri V neknTaSua sivrceSi 0,5-1sm-iT SigniT medioklavikuluri xazidan.
zogjer kargad Cans saZile arteriebis pulsacia, ufro simpaTikuri tonusis
siWarbisas. majiscema xSirad labiluria da mniSvnelovan farglebSi meryeobs
dRe-Ramis ganmavlobaSi. auskultaciuri monacemebidan aRsaniSnavia: xSirad I
tonis fiziologiuri gaoreba mwvervalze, II tonis fiziologiuri gaoreba fuZeze,
fiziologiuri III toni. am ukanasknelis warmoSoba dakavSirebulia parkuWebis
vibraciasTan maTi protodiastolaSi swrafi avsebis gamo. fizikuri datvirTvisas es
toni, rogorc wesi, qreba. iSviaTad gvxvdeba fiziologiuri IV toni. igi advilad
SeiZleba SegveSlos II tonis gaorebaSi. am tonis warmoSobas safuZvlad udevs
bradikardiis pirobebSi winagulebis sisxliT gadavseba da maTi Zlieri SekumSva.
amdenad, es toni winagulovania. III da IV tonebi SeiZleba paTologiuri iyos,
amitom saWiroa am tonebis arsebobis SemTxvevaSi maTi fonokardiografiuli
diferencireba.
janmrTel mozardebSi xSiria sistoluri Suili gulis mwvervalze. amis mizezi
SeiZleba iyos Seusabamoba gulis SedarebiT did moculobasa da msxvili
sisxlZarRvebis SedarebiT moculobebs Soris. mizezi SeiZleba iyos, agreTve,
14
papilaruli kunTebis disfunqcia simpaTikuri tonusis siWarbisas. xSiria
mozardebSi sunTqviTi ariTmia. xSirad sayuradReboa normis mosazRvre
arteriuli wneva (140/90 mm.v.sv).
rentgenologiurad, yvela mozards normaSi yvela rkali kargad aqvs
gamoxatuli da gulis ganivi zoma 11sm-ze aranaklebia. patara hipoevoluciuri
gulisaTvis damaxasiaTebelia misi gulmkerdSi Sualeduri mdgomareoba, rkalebis
dagrZeleba, ganivi zomebis simcire 8,5-9,5sm.miokardiumis Wabukuri
hipertrofiisaTvis damaxasiaTebelia ganivi zomebis gadideba 12-14sm-mde,
mwvervalis momrgvaleba, marcxena parkuWis gadideba. eleqtrokardio-
grafiulad damaxasiaTebelia sunTqviTi ariTmia, V 1-2 ganxrebSi xSirad QRS
kompleqsis dakbilva. ST segmenti gulmkerdis ganxrebSi SeiZleba izoxazze
maRla iyos 1-2 sm-iT, upiratesad vagotoniis dros. T kbili SeiZleba iyos uaryofiTi
III ganxraSi (magram aVF-Si am dros dadebiTi unda iyos). mozardebSi xSiria U
kbili, romelic dvrilisebri kunTebis repolarizaciis gamomxatvelia. normis
variantia mozardebSi sinusuri riTmis migracia. xSiria pubertatul periodSi
parkuWTa naadrevi repolarizaciis sindromi. es sindromi xasiaTdeba gulis
SemobrunebiT sigrZiv RerZze saaTis isris sawinaaRmdego mimarTulebiT, ST
segmentis izoxazs zemoT cToma (am dros gamoburculoba qvemoT aris
mimarTuli), wertil j-s arsebobiT. am sindromis mizezad iTvleba depolarizaciis
ubnebis zeddeba repolarizaciis procesze. am sindroms xSirad Tan erTvis
SemarTebeli qsovilis displazia (Zabriseburi gulmkerdi), mitraluri prolafsi,
marcxena parkuWis cru qordebi. es sindromi SeiZleba arsebobdes sxvadasxva
paTologiuri mdgomareobis drosac da amitom safuZvlian gamokvlevas
saWiroebs.
veloergometriis dros submaqsimalur datvirTvamde mozardebSi SeiZleba
gamovlindes P kbilis voltaJis zomieri momateba, R kbilis dadableba, ST
segmentis aRmavali depresia.
saWiroa, fonokardiogramaze sistoluri Suilis arsebobisas, fiziolo giuris
garCeva paTologiurisagan. I-is SemTxvevaSi igi klebadia, ar ikavebs sistolis 2/3-
ze mets da I tonisagan intervaliT aris gamoyofili. paTologiuri, rogorc wesi,
holosistoluria, SeuRlebulia I tonis SesustebasTan da misgan intervaliT ar aris
gamoyofili. funqciuri SeuRlebisaTvis damaxasiaTebelia cvalebadoba. Suili
sustdeba xolme vertikalur mdgomareobaSi gadasvlisas da mcirdeba fizikur
datvirTvaze.

15
 mozardebs fkg-ze xSirad aReniSnebaT III da IV tonis gapoba. III tonis
gapoba vlindeba 1-3 dabalamplituduri rxeviT, daSorebulia II tons 0,11-0,15wm-
iT, maRalsixSiriania, aWarbebs simaRliT I da II tonebs.
mitraluri sarqvlis gaxsnis xma - am fenomens Tan axlavs sxva paTologiuri
bgerebic - I tonis gaZliereba, diastoluri Suili da sxva.
IV toni vlindeba 2-3 dabalamplituduri rxeviT. iwyeba P kbilis dawyebidan
0,04-0,16wm-Si da mTavrdeba I tonis dawyebamde 0,02-0,14 wm-iT adre.
eqokardiografiuli suraTi 15-17 wlis asakSi uaxlovdeba mozrdilisas. rogorc
zemoT iTqva, sistoluri Suilis arsebobisa da naadrevi repolarizaciis sindromis
arsebobisas mizanSewonilia mozardis eqoskopiuri gamokvleva. am dros
naxuloben damatebiT qordebs, gulis saknebisa da msxvili sisxlZarRvebis
Taviseburebebs. yvelaze xSiria parkuWTa Rruebis trabekuloba, damatebiTi
qordebi, dvriliseburi kunTebis adgilmdebareobaSi cvlilebebi da maTi
danawevreba, damatebiTi dvriliseburi kunTi. am mdgomareobebs xSirad Tan
erTvis hiperkinetikuri tipis hemodinamika.
riTmografiuli gamokvleva mniSvnelovania gul-sisxlZarRvTa sistemis
funqcionaluri rezervebis Sesaswavlad. erT-erTi meTodi am mizniT aris
dozirebuli sunTqva (6-7 sunTqviTi cikli wuTSi) da am fonze kardiointervalebis
Seswavla. meTodis arsi mdgomareobs R-R intervalebis dajgufebaSi sididis
mixedviT da saboloo suraTis mixedviT nervuli regulaciis tipis
gamoaSkaravebaSi.QaRniSnuli meTodiT gamokvlevisas dgindeba, rom
axalgazrdebis umravlesobas aqvs nervuli sistemis regulirebis normotonuri tipi,
iSviaTad simpaTiko- da vagotonuri tipebi. simpaTikotonuri tipi xSirad aqvT
gogonebs menstruaciis Camoyalibebis pirvel weliwads.. SemgomSi maTSic
Zlierdeba qolinerguli aqtivoba.
mozardTa asakSi gul-sisxlZarRvTa sistemis funqciis Seswavla eqims aZlevs
saSualebas sworad gansazRvros organizmis Taviseburebebi da droze
gamoavlinos SesaZlo paTologiuri gadaxrebi.
mozardobis periodSi Zalzed maRalia Jangbadis mimarT moTxovnileba.
amis gamo intensiurad viTardeba sasunTqi sistema - bronqebi, filtvis qsovili.
amave dros alveolebis masa, sasunTqi kunTebis simZlavre CamorCeba
mozrdilebisas. mozardobis periodSi aqtiurdeba garegani sunTqvis funqcia,
SeimCneva tendencia hiperventilaciisaken, TandaTanobiT vlindeba sqesobrivi
gansxvavebebi –biWebSi matulobs sisxlis tutovani rezervi, CO 2-is parcialuri
wneva alveolebSi da arteriul sisxlSi. filtvebis intensiuri zrda iwyeba 12 wlidan
16
da 24 wlis asakSi aRwevs maqsimums. mozardebSi Jangbadis gamoyenebis
koeficienti ufro dabalia, vidre mozrdilebSi. mozardis organoebi ufro cudad
egueba hipoqsias. mTis avadmyofoba maT SeiZleba 2000 m simaRleze
gauCndeT, rac TiTqmis arasodes ar emarTebaT mozrdilebs.
mozardTa sasunTqi sistemis morfo-funqciur Taviseburebebis klinikuri
mniSvneloba Semdegia -
- bronqebis swraf zrdasTan dakavSirebiT maTi xrtilovani safuZveli
Txeldeba, wvrili bronqebis kedlebs uCndebaT tendencia erTmaneTTan
mikrobis. es xels uwyobs maTSi lorwos dagrovebas, bronqoeqtaziebis
formirebas, paTologiuri procesis qronizacias;
- filtvebis hiperventilacia ukve mosvenebiT mdgomareobaSi aqveiTebs
sasunTqi aparatis sarezervo SesaZleblobebs;
- mozardebSi asTeniuri aRnagobisa da vegetodistoniisas xSiria sakaduri
sunTqva;
- xSiri sunTqva amcirebs filtvebis moculobas, auskultaciis dros iqmneba
STabeWdileba sunTqviTi xmianobis Sesustebis.
gansakuTrebuli mniSvnelobisaa saWmlis momnelebeli sistemis asakobrivi
Taviseburebani. am ukanasknelis arasrulfasovanma mdgomareobam SeiZleba
gamoiwvios mozardis fizikuri, sqesobrivi da gonebrivi CamorCenac ki.
saWmlis momnelebeli sistema heteroqronulad viTardeba - sarZeve kbilebi
icvleba ZiriTadiT 13-14 wlisaTvis, sanerwyve jirkvlebi ki ganagrZoben zrdas 50
wlamdec ki. araTanabrad viTardeba kuWis sekretoruli funqciac, definitur
mdgomareobas igi 15-16 wlis asakSi aRwevs. pubertatobis dasawyisSi vlindeba
kuWis sxvadasxva jirkvlis ganviTarebis heteroqronizmi – ufro swrafad
viTardeba mTavari jirkvlebis Semomfarglavi da damatebiTi ujredebi (13-14
wlisaTvis), mTavari ujredebi ki – mogvianebiT (15-16 wlisaTvis). am mizeziT
mozardebSi xSiria hiperqloriduli mdgomareoba. aseve araTanabad viTardeba
hepatobiliaruli sistema, naRvlmdeni funqcia sabolood mxolod 15-16 wlisaTvis
yalibdeba. saWmlis momnelebel traqts midrekileba aqvs motoruli
hiperaqtivobisaken, aqedan gamomdinareobs motorikis xSiri darRveva,
diskineziebi. aqtiuri sportuli cxovreba 3-5 wliT aCqarebs kuWis sekretoruli
aparatisa da hepatobiliaruli sistemis saboloo Camoyalibebas (momwifebas).
mozardobis periodi kritikulia wyal-mineraluri cvlis regulaciis Camoyalibebis
TvalsazrisiT. osmoregulaciis SesaZleblobebi mozardebSi mniSvnelovnad
dabalia mozrdilebTan SedarebiT. wylis mimarT moTxovnileba mozardebSi
17
metia, vidre mozrdilebSi. am ukanasknelTa dones igi 14 wlisaTvis uaxlovdeba.
arsebobs Sexeduleba, rom mozardebSi asimilaciis procesebis siWarbe
gantvirTavs Tirkmelebs.
sisxlis suraTi mozardebSi mozrdilebisas 18 wlisaTvis uaxlovdeba,
gogonebSi stabilizacia ufro adre xdeba.
imunuri sistema morfologiurad savsebiT momwifebulia, magram
funqciurad jer kidev ara. Timusi maqsimalur wonas pubertatuli asakis
dasawyisSi aRwevs, amis Semdeg iwyeba misi involucia. limfuri qsovilis masa
udidesia 10 wlisaTvis. garkveuli roli fizikuri da seqsobrivi ganviTarebis
daTrgunvaSi SeiZleba citokinebs (simsivneebis nekrozis faqtorebi) da
interleikins miuZRodeT. isini Trgunaven albuminis sinTezs da ukargaven
mozardebs madas. maTi done sisxlSi maRalia infeqciebiT xSirad moavade
bavSvebSi. amis gamo, es mozardebi fizikuri da zogjer gonebrivi
ganviTarebiTac CamorCebian TavianT Tanatolebs. pubertatuli naxtomi
astimulirebs humoralur da Trgunavs ujredul imunitets. gazrdilia mgrZnobeloba
tuberkulozisadmi, autoimunuri da limfoproliferaciuli daavadebebisadmi,
sabolood formirdeba imunuri pasuxis Zlieri da susti tipebi.
imunuri homeostazis maCveneblebis meryeoba mozardebSi Zalian
mniSvnelovania. 8-16 wlis moswavle biWebs gazafxulze ematebaT T
helperebis, T limfocitebis raodenoba, T helperebis T kilerebTan Sefardeba,
zafxulSi makrofagebis, xolo SemodgomiT T helperebis raodenoba.
gogonebSi T helperebis, Ig M da GG-is raodenoba, T helperebis T
kilerebTan Sefardeba metia, vidre biWebSi. es gasaTvaliswinebelia maTi
imunologiuri statusis Sefasebisas.
imunur statusze did gavlenas axdens fizikuri varjiSi. ase magaliTad, 11-17
wlis axalgazrda sportsmenebSi kanis sinjis SeswavliT gamovlinda, rom am
jgufSi kanis automikrofloris siuxve gacilebiT maRali iyo, vidre intensiurad
aramovarjiSe axalgazrdebSi. zomieri fizikuri wvrTna, piriqiT, xels uwyobs
neitrofilebs aqtivacias.
gamovlenilia imunuri statusisi damokidebuleba menstrualuri ciklis fazebze.
ovulaciuri pikis dros gogonebi yvelaze ufro metad arian mgrZnobiareni
infeqciebis mimarT, es pirobiTad imunodeficituri mdgomareoba estrogenebis
moqmedebiTaa ganpirobebuli.

18
 mozardebSi SedarebiT ufro xSirma narkomaniam, tabakizmma,
alkoholizmma, kvebiTma darRvevebma SeiZleba xeli Seuwyos meoradi
imunodeficituri mdgomareobebis ganviTarebas.

mozardTa janmrTeloba da janmrTelobisTvis saxifaTo qceva.

epidemiologiuri monacemebi

monacemebi Cvens qveyanaSi mozardTa daavadebianobaze, avadobaze,

sikvdilianobaze da janmrTelobasTan dakavSirebuli qcevis Sesaxeb Zalze
mwiria. amis gamo problemaSi garkvevis mizniT mizanSewonilad miviCnieT
msoflio monacemTa mimoxilva, upiratesad dasavleTis qveynebis
monacemebze aqcentiT. aRsaniSnavia, rom mozardobis periodSi sikvdilianoba
sxva asakobriv periodebTan SedarebiT sikvdilianoba yvelaze dabalia, magram
igi ar iCens tendencias Semcirebisaken, piriqiT, zogan matulobs kidec. imasac
unda mieqces yuradReba, rom sikvdilianobac, avadobaca da daavadebianobac
upirvelesad ganpirobebulia principulad Tavidan acilebadi mizezebiT. pirvel rigSi
es aris janmrTelobisTvis sarisko qceva.
mozardTa avadobis, daavadebianobisa da sikvdilianobis statistikis
Seswavlisas unda vicodeT romel wyaros eyrdnoba es monacemebi. statistikuri
monacemebi SeiZleba momdinareobdes saxelmwifo da kerZo institutebisagan,
calkeuli eqimisgan, hospitalizaciis raodenobis monacemebidan, sagzao
SemTxvevaTa statistikidan, policiisagan, ganaTlebis sistemidan da sxv.
mozardTa statistikis Segroveba sakmaod rTuli amocanaa. sxvadasxva saagento
gansxvavebuli asakobrivi monacemiT operirebs. zogierTi monacemi exeba
Zalian mcire asakis bavSvebs, an mozardebs, romelTa asaki sakmaod didia.
gamomdinare naTqvamidan, daavadebianobis, avadobisa da sikvdilianobis
done sxvadasxva monecemebis mixedviT meryeobs. saSualebebi, romlebiTac
mozardTa janmrTelobis monacemebi miiReba arasaimedoa. isini iSviaTad
CaiTvlebian samagaliTod im populaciaSi, romlis mimarTac gamoiyenebian.
amgvarad, ar arsebobs standartuli monacemebi, romlis mixedviTac zustad
Sefasdeba narkotikebis gamoyeneba, seqsualuri aqtivoba, Zaladoba, iseT
gonebriv daavadebaTa ganviTarebis procesi, romlebic ar Tavsdeba zust

19
diagnostikur CarCoebSi. kriminaluri statistika policiis monacemebs eyrdnoba
da ar moicavs SemTxvevebs, romelic ar iqnen gacxadebuli. monacemebi zogjer
moicavs daavadebul axalgazrdebs, zogjer ki mxolod msjavrdadebulebs.
bevri statistikuri monacemi eyrdnoba SerCeviT populacias (mag.
umaRlesi skolebis mimoxilva) da, amdenad, ar miesadageba mozardTa
populacias, romelic gansakuTrebul saswavleblebSi swavlobs, an saerTod ar
swavlobs. mimoxilvebi eyrdnoba saanketo monacemebs, anketis Semvsebis
monacemi ki SeiZleba bolomde gulwrfeli arc iyos. garda amisa monacemi
SeiZleba mowodebuli iyos meore pirisagan, mag. mSoblebisa da eqimebisagan,
romlebmac arc Tu ise iSviaTad SeiZleba ar icodnen sruli simarTle mozardis
Sesaxeb. zogjer mozardi jandacvis dawesebulebebs mSoblebisagan farulad
mimarTavs, gansakuTrebiT iseT sakiTxebze, rogoricaa ojaxis dagegmva an
sqesobrivi gziT gadamdebi daavadebebi.
aSS bolo wlebis statistikuri monacemebiT mozardTa sikvdilianobis
ZiriTadi mizezebia:
 mkvleloba
 avtosagzao SemTxvevebi
 TviTmkvleloba
 avTvisebiani simsivneebi
 gulis daavadebebi
 Sidsi
 ganviTarebis Tandayolili defeqtebi
- filtvis daavadebebi.
1992 wels inglissa da uelsSi 10-19 wlis asakobriv jgufSi sikvdilis 1922
SemTxvevidan sikvdilis mizezi 53%-Si (1021) travma an mowamvla iyo, xolo
14%-Si neoplazma, rac sikvdilis meore yvelaze xSir mizezs warmoadgenda.
sikvdilis mesame xSiri mizezi nervuli sistemis daavadebebi, xolo meoTxe
respiratoruli problemebi iyo.
didi britaneTis statistikuri monacemebiT mozardebSi yvelaze gavrcelebuli
samedicino-sociluri problemebia Tambaqos moweva. mozardebSi
mwevelobis Taobaze arsebuli monacemebi Semdegia: 16 wlis asakis
mozardebis mesameds sigareti arasodes mouwevia, mesameds, ubralod,
usinjia mowevis dawyeba, magram maleve daunebebia Tavi, mesamedi
mwevelia - amaTgan, zogierTi Tambaqos regularulad eweva, zogi ki

20
 xandaxan. kvlevebiT gamovlinda, rom mweveli mozardebisaTvis
damaxasiaTebelia Semdegi niSnebi:
 mwevelebi arian am mozardebis ojaxis wevrebi da megobrebi;
 isini, aramwevelebTan SedarebiT Tvlian, rom naklebi Sansi aqvT
akontrolon TavianTi cxovreba;
 mweveli mozardebi naklebad Tavdajerebulni arian, cudi
warmodgena aqvT sakuTar Tavze, xSirad nerviuloben;
 mweveli mozardebi Tavisufal dros fizikur muSaobaSi an, piriqiT,
usaqmurobaSi atareben.
alkoholis moxmarebas mozardebi sul ufro axalgazrda asakSi iwyeben,
daaxloebiT, 10-11 wlidan. arsebobs TvalsaCino urTierTkavSiri adreul asakSi
alkoholis moxmarebis dawyebasa da mogvianebiT mZime alkoholizmis
Camoyalibebas Soris. kvlevebiT gamovlinda, rom alkoholuri sasmelis miRebis
Semdeg Tineijerebi ufro metad midian SemTxveviT sqesobriv kontaqtebze,
naklebad iyeneben am dros kondoms.
dadgenilia mWidro urTierTkavSiris arseboba mozardebSi alkoholis
moxmarebas, stressa da problemebis gadalaxvis unars Soris. xangrZlivi
kvlevebiT gamovlinda, rom alkoholis moxmarebis xasiaTi mozardobis periodSi
aranairad gansazRvravs misi moxmarebis xasiaTs mozrdil asakSi, magram
mozardebSi alkoholis moxmarebis garkveuli reJimi: xSiri simTvrale, alkoholis
moxmarebis naadrevi dawyeba da sma, ZiriTadad, sazogadoebrivi TavSeyris
adgilebSi, zrdasrul asakSi seriozuli alkoholur problemebis ganviTarebas
moaswavebs.
pirveli seqsualuri gamocdilebis asaki ukanaskneli oTxi dekadis
ganmavlobaSi gogonebisaTvis 16-dan 14 wlamde, xolo biWebisaTvis 15-dan 13
wlamde Semcirda (seqsualuri gamocdileba gulisxobs sqesobrivi urTierTobis
nebismier gamovlinebas (kocna, mofereba da a.S.) da ara, aucileblad,
sqesobriv aqts. amave periodSi pirveli sqesobrivi aqtis asaki biWebSi 19-dan
17-mde, xolo gogonebSi 20-dan 17-mde Semcirda. 16-24 wlis asakobrivi jgufis
pirTa Soris qalebis 2,7% da mamakacebis 9,3% aRniSnavs, rom pirveli
sqesobrivi kontaqti 15 wlamde hqonda. qalebis 33,8% da makakacebis 55,8%
miuTiTebs, rom 15 wlis asakamde hqondaT garkveuli seqsualuri urTierTobis
gamocdileba. amave jgufis gamokiTxuli qalebis 18,7%, xolo mamakacebis
27,6% aRniSnavda, rom sqesobrivi kontaqti hqonda 16 wlis asakSi.
aRsaniSnavia is garemoebac, rom ukanasknel aTwleulSi Semcirda pirveli
21
sqesobrivi kontaqtisas kontracefciis gamoyeneba. axalgazrda qalebisa da
mamakacebis naxevari, visac sqesobrivi kontaqti 16 wlis asakamde hqonda
miuTiTebs, rom am dros arc mas da arc mis partniors ar gamouyenebia raime
kontracefciuli saSualeba.
aSS-Si Catarebuli kvlevebiT gamovlinda, rom ukanasknel dekadaSi
aRiniSna mozardTa seqsualuri gamocdilebis zrdis tendecia. amis Sedegad
dramatulad gaizarda Tineijerebis orsulobis maCvenebeli. igive situaciaa
gaerTianebul samefoSic. ufro adreuli kvlevebis monacemebiT moxda imis
demonstrireba, rom sqesobrivad aqtiuri Tienijerebis didi nawili ar iyenebs
kontracefcias sqesobrivi aqtivobis dawyebidan pirveli wlis ganmavlobaSi.
SekiTxvaze, Tu ram ganapiroba arasasurveli orsulobis aRmoceneba,
mozardebis 50% pasuxobda, rom “`vfiqrobdi, rom ar davorsuldebodi~, 25%
Tvlida, rom sqesobrivi kontaqti Tvis im periodSi hqonda, rodesac daorsulebis
Sansi minimaluri iyo, 20%-Si orsuloba daugegmavi sqesobrivi kontaqtis
Semdeg dadga, 5% Tvlida, rom `Zalian axalgazrdaa imisaTvis rom
dafexmZimdes~ da mxolod 3%-ma araferi icoda kontracefciis Sesaxeb.
1975 wels Catarebuli kvleviT gamovlinda, rom orsuli Tineijerebis 23%-s
hqonda amis survili, xolo 19% iyenebda kontracefcias, romelic, rogorc gairkva,
araefeqturi aRmoCnda. es maCveneblebi uaxlesi kvlevebiTac dasturdeba.
mozardebis sqesobriv cxovrebas spontanuri xasiaTi aqvs. Cveulebriv, es
sxvadasxva partniorTan araregularuli sqesobrivi kontaqtebiT ganisazRvreba.
adamianis imunodeficits virusiT dainficirebis maRali riskis gamo Tineijerebs
urCeven isargeblon kontracefciis barieruli meTodebiT, kerZod kondomiT.
fineTSi Catarebuli kvlevebiT gamovlinda, rom kondomis reklamirebam
ganapiroba hormonuli kontracefciis popularobis Semcireba, amis fonze maRalia
arasasurveli orsulobis SemTxvevaTa zrdis riski, vinaidan izrdeba naklebad
efeqturi kontracefciis (rogoric kondomia) moxmarebis maCvenebeli, metad
efeqturTan (hormonuli kontracefcia) SedarebiT.
erT-erTi kvlevis mixedviT biWebis 90% acnobierebs kondomis
gamoyenebis mniSvnelobas, magram mxolod 15% iyenebs mas yovelTvis, 50%
ki iSviaTad an arasodes sargeblobs dacvis am saSualebiT.
ukanasknel periodSi SotlandiaSi Catarda kvleva, romelic TineijerTa
orsulobaze socialur-ekonomiuri faqtorebis zegavlenis Seswavlas isaxavda
miznad. aRmoCnda, rom Tineijerebis orsulobis maCvenebeli maRalia dabal

22
socialur fenaSi, da Tanac, am jgufSi abortiT orsulobis Sewyveta ufro iSviaTad
xdeboda.
mozardebisaTvis damaxasiaTebeli ramodenime niSani arTulebs am jgufSi
kontraceptivebis gamoyenebas:
 mozardebis azrovneba iSviaTad ayalibebs momavlis realur xedvas;
 mozardisaTvis, romelic sakuTar Tavs `umaqnisad~ da `aramniSvnelovnad~
miiCnevs orsuloba sasurveli (misaRebi) gamosavalia;
 zogjer mkveTrad dominirebs `imunitetis miTi~ (mag. `es me ar SeiZleba
damemarTos~);
 orsuloba damoukideblobis demonstrirebis saSualebaa, magram amave dros
igi mSoblebze xangrZlivi damokidebulebis kargi winapirobaa.
ase rom, orsuloba Tineijerebis seqsobrivi cxovrebis potenciuri
gamosavalia. samedicino TvalsazrisiT, Tineijeris orsuloba dedisa da
nayofisaTvis maRal riskTanaa dakavSirebuli (mcire wonis nayofi, anemiis
maRali riski, hipertenzia, maRali perinataluri riski). Tineijerebi orsulobis gamo
veRar amTavreben skolas, uWirT swavlis gagrZeleba, amas mohyveba finansuri
sirTuleebi, ganyeneba da socialuri izolacia. Tineijer dedebSi maRalia
mwevelobis maCvenebeli. Tineijeri dedebis Svilebi, romlebic socialuri
sirTuleebis garemoSi izrdebian, xSirad Tavad dgebian igive problemis winaSe
anu bavSvebis am jgufSi maRalia Tineijerobis asakSi orsulobis riski.
inglisis Crdilo-dasavleTSi mdebare rva skolaSi 14-15 wlis mozardebis jgufs
dauriges kiTxvarebi, romlebsac isini Tavad Seavsebdnen da, Tanac,
uzrunvelyofili iqneboda sruli konfidencialobis garantia. respondentebs
usvamdnen or SekiTxvas, romelic aralegaluri medikamentebis, kerZod
sxvadasxva gamxsnelisa da `magiuri~ sokoebis moxmarebas Seexeboda.
SekiTxvebi aseTi saxis iyo: (1) moxvedrilan Tu ara isini rodesme iseT situaciaSi,
sadac maTi Tanatolebi an sxvebi erTmaneTs am nivTierebebs sTavazobdnen,
da (2) rodesme Tu ucdiaT amgvari nivTierebebis gamoyeneba. respondentebis
55%-ma aRniSna, rom misTvis SeuTavazebiaT, sul mcire, erTi saxis aralegaluri
preparati. bavSvebis 52% aRwers, rom maT SesTavazes haSiSi, 36% miuTiTebs
LSD-s, 26% amfetamins, 22% gamxsnels, 21% ‘`magiur~ sokoebs, 21%
nitritebs da 18% MDMA-s (eqstazi). bavSvebis Svidi procenti aRwers, rom
aRmoCnda situaciaSi, sadac kokains sTavazobdnen, 4%-s ki hqonda Sansi
ecada heroini. mozardebis umravlesoba, visac aralegaluri nivTierebebis
gamoyenebas sTavazobdnen uars ambobda amaze, Tumca 10-dan 6 erTxel
23
mainc `sinjavda~ maT. 14-15 wlis gogonebis 36%-s gasinjuli hqonda, sul mcire,
erTi medikamenti mainc.
ojaxebis (Sinameurneobebis) sociologiuri kvlevis Sedegebis mixedviT
(1993) 5-15 wlis vaJebis 21% da gogonebis 16% Tvlis, rom xangrZlivi
avadmyofoba aqvs. amave asakobriv jgufSi gogonebis 10-sa da biWebis 9%-s
miaCnia, rom SezRuduli aqvs moqmedebis saSualeba.
Sinameurneobebis sociologiuri kvlevis Sedegebis (didi britaneT)
Semdgomi analiziT gamovlinda, rom mozardebi ojaxis eqimebs weliwadSi
saSualod or an samjer momarTaven. 1993 wlis monacemebiT saavadmyofos
ganyofilebas ambulatoriuli pacientebisaTvis an gadaudebeli daxmarebisaTavis
mimarTavda 5-15 wlis biWebis 12% da gogonebis 10%.
saavadmyofoSi mimarTvis Sesaxeb detaluri informacia Semdegia: 10 wlis
asakobriv jgufSi hospitalSi mimarTvaTa 22% zogad pediatrTan momarTvaze
modioda, 24% zogad qirurgiaze, 23% yel-yur-cxviris qirurgiaze, 20% travmasa
da orTopediaze. 14 wlis asakisaTvis saavamyofos pediatrs mimarTavda mxolod
bavSvebis 6%. 16 wlis asakisaTvis gogonebis hospitalSi mimarTavTa 24%
ginekologTan mimarTvaze modioda, 1%-ze naklebi zogad pediatrze, xolo
biWebis mimarTvaTa 40%-s orToped-travmatologTan mimarTva Seadgenda.
biWebs Soris hospitalSi mimarTvis yvelaze xSiri mizezi qala-tvinis travma,
xolo gogonebis mimarTvis uxSiresi mizezi 15-16 wlis asakSi orsulobis xelovnuri
Sewyveta iyo. SedarebiT mozrdil TineijerebSi sakmaod maRali iyo Tavis
mowamvlis SemTxvevebi.
mozardebis hospitalSi mimarTvaTa ZiriTadi mizezi qirurgiuli da ara
Terapiuli samedicino daxmarebis aucilebloba iyo. problemebic, umTavresad,
qceviTi faqtorebis da ara paTologiuri procesis progresirebis fonze iyo
aRmocenebuli.
ukanasknel wlebSi mniSvnelonad gaumjobesda prevenciuli stomatologia, ris
Sedegadac 15 wlis asakis mozardTa ricxvi, romelTac kariesi absoliturad ar
aReniSneboda 8%-dan 40%-mde gaizarda (inglisi da uelsi 1993). Tumca,
amJamad, xilis wvenSi Saqrebis Semcvelobis matebis gamo mosalodnelia
kariesis SemTxvevaTa zrda SedarebiT mcire asakis bavSvebSic.
fsiqikuri problemebi ganimarteba, rogorc qceviTi paTologia an socialuri
urTierTobis garTuleba, romelic imdenad mniSvnelovani da mZimea, rom xels
uSlis mozardis normalur ganviTarebas an iwvevs uunarobas - did britaneTSi

24
aRiniSneba 16 wlamde asakis mozardebis 2,4%-Si. es maCvenebeli am
asakobriv jgufSi ufro maRalia, vidre SedarebiT mcire asakis bavSvebSi.
1991 wels avtosagzao SemTxvevebis 25,6% iyo 10-14 wlamde mozardebSi,
42,5% 15-dan 19 wlamde da 34,2% ki 20-24 ww axalgazrdebSi.
ubeduri SemTxvevebi velosipedistebis monawileobiT imave 1991 wels 189
iyo 1 mln mosaxleobaze, amasTan 7-jer meti vaJebSi, vidre gogonebSi.
igive statistikuri monacemebiT gamovlinda, rom studentebis 21,7%
arasodes an Zalian iSviaTad iyenebs uSiSroebis Rvedebs, rodesac
avtomanqanas marTavs da sxva.
mTel aSS-Si 1991 wels moswavleTa 25% ijda motociklze. maTgan 43,8%
arasodes an iSviaTad iyenebda Cafxuts. moswavleTa 20% (upiratesad vaJebi)
atarebda iaraRs (pistoleti, dana, xelketi).
38,7% statistikuri monacemebis Segrovebis wels monawileobda CxubSi.
amaTgan 42%-s dasWirda saeqimo daxmareba.
kvlevaSi moxvedrilTagan 4,5%-ma gaacdina skolis erTi dRe mainc imis
gamo, rom skolaSi swavla ar iyo usafrTxo (Cxubis SesaZlebloba, iaraRiT
muqara da sxva). yvela rasobriv jgufSi konfliqtSi ufro xSirad CarTulni iyvnen
biWebi, vidre gogonebi.
gamokiTxuli moswavleebis 24,1% ufiqria TviTmkvlelobaze, upiratesad
espanuri eTnosis gogonebs. mozardTa 8,7%-s Seusrulebia TviTmkvlelobis
mcdeloba, upiratesad gogonebs.
1991 w 12-17 ww. mozardebis 46,4% da 17-25 ww 90% dauleviaT
alkoholuri sasmelebi. eTnikurad, aseTebSi Warbobdnen TeTrkaniani
amerikelebi (zangebTan da espanelebTan SedarebiT).
britaneli medikosebis monacemebiT narkotikuli saSualebebis gamoyenebis
statistika aseTia: 18-25 ww axalgazrdebis 50%-s gausinjavs marixuana, 12-17
ww mozardebs minimum erTxel gausinjavT kokaini, umaRlesi skolebis
studentebis 7%-s erTxel mainc gausinjavs igive kokaini. sakmaod xSiria
halucinogenebisa da sxvadasxva tipis inhalantebis xmareba.
1995 wlis statistikuri monacemiT aSS maRali klasis moswavleTa 2%-s
gaukeTebia narkotikis ineqcia. imave, 1995 wels moswavleTa 71%-s mouwevia
sigareti, upiratesad maRali klasis moswavleebs. 11,4% ReWavda Tambaqos.
moswavleTa 3,7% 1995 wels gamouyenebia anaboluri steroidebi.
mozardTa seqsualuri qceva mimarTebaSia am gziT gadatanil
daavadebebTan da araganzraxul (arasasurvel) orsulobasTan. 1995 wels
25
Catarebuli, axalgazrdebis sarisko moqmedebis mimoxilvis SedegebiT, maRali
klasis moswavleTa 50,3%-s hqonia sqesobrivi kavSiri. es ufro xSiri iyo
Savkanian moswavleebSi. mTeli qveynis masStabiT moswavleTa 18%-s hqonia
sqesobrivi kavSiri 4 an met partniorTan. seqsualuri aqtivoba ufro metad
gamovlinda Savkanian da espanuri warmoSobis vaJebSi, TeTrkanianTa Soris ki
ufro qalebSi. gamovlinda, rom maRali klasebis moswavleTa 54% iyenebda
prezervativs sqesobrivi kavSiris dros.
yovelwliurad aSS-Si 30 mln axalgazrda avaddeba sqesobrivad gadamdebi
daavadebebiT. maTgan 41% 20-dan 24 wlamdea. mozardebSi yvelaze
gavrcelebuli sqesobrivi gziT gadamdebi daavadebebia: qlamidiozi, hepatiti,
sifilisi, adamianis imunodeficitis virusi. 1995 w 15-24 ww axalgazrdebSi yvelaze
xSirad sqesobrivad gadaitaneboda gonorea.
sqesobrivi gziT gadamdeb daavadebaTa sixSiresTan erTad maRali iyo
arasasurveli orsulobebis ricxvi. maTi maCvenebeli 15-dan 19 wlamde
mozardebSi Seadgenda 21%-s. maTgan naxevari miyvanil iqna bolomde, xolo
1/3 abortiT dasrulda.
abortebis udidesi raodenoba aSS-Si 15 welze naklebi asakis mozardebze
modis. bolo wlebSi aSS-Si SeiniSneboda im mozardTa raodenobis zrda, romelTa
orsuloba mSobiarobiT sruldeboda, rac abortebis ricxvis daqveiTebaze
metyvelebs. aseTi tendencia, SesaZloa gamomdinareobdes, rogorc mozardTa
ganwyobis Secvlidan da maTi survilidan miitanon orsuloba bolomde, ise
kanonSi cvlilebebze. es ukanaskneli iTvaliswinebs abortze mSobelTa
Tanxmobis miRebas, aucilebel mosacdel periods, rac albaT moqmedebs
mozardebze da acvlevinebs maT Tavdapirvel survils gaikeTon aborti
(saqarTveloSic msgavsi kanoni moqmedebs).

faqtorebi, romlebic zegavlenas axdenen mozardebis

janmrTelobaze

Znelad gasagebi ar unda socialur-ekonomikuri, kulturuli, eTnikuri da

genderuli faqtorebis mniSvneloba mozardis normaluri ganviTarebisa da
janmrTelobisTvis. pirvel rigSi ojaxi Tavisi socialur-ekonomikuri statusiT aris is

26
ZiriTadi garemo, romelic qmnis safuZvels mozardis momavali cxovrebisaTvis.
ojaxs mravalnairi forma aqvs. bevri qveynis tradiciul periferiul raionebSi ojaxebi
mravalricxovania - Sedgeba ramodenime Taobis warmomadgenlebisagan da
maT ematebaT biZaSvil-mamidaSvilebi da sxva. aseTi ojaxebi mtkice bazisia
materialur-moraluri TvalsazrisiT axalgazrdisaTvis. Tu ojaxi ver uyris mtkice
safuZvels mozards socialurad, ekonomikurad, kulturulad da a.S., maSin igi
uneblieT Tesavs problemebs, romlebis winaSe dganan dRes axalgazrdebi.
industriul qveynebSi ojaxebi TandaTanobiT SemadgenlobiT Semcirda da
amJamad ZiriTadad Sedgeba mSoblebisa da Svilebisagan. aseT ojaxSi naklebad
xorcieldeba mSoblismieri kontroli, wina planze gamodis moraluri, ganaTlebiTi
da SromiTi xelmZRvaneloba.
ojaxis xsenebuli orive tipi SeiZleba CaiTvalos ojaxis modelad.
Tanamedrove epoqaSi, samwuxarod, Zalian xSiria iseTi samwuxaro faqti,
rogoricaa col-qmris gaSoreba. yvela qveyanaSi katastrofulad imata martoxela
mSoblebis (upiratesad dedebis) ricxvma. gasagebia, rom aseT arasrulfasovan
ojaxSi gazrdili bavSvi moralurad, agreTve socialurad, ekonomiurad da
kulturulad iCagreba. aseTi garemodan mozardebi Zalian xSirad garidebas
cdiloben da, rogorc wesi, quCis gavlenis qveS eqcevian. yvela aqedan
gamomdinare SedegiT. Tundac rom mozardi ar gaecalos am garemos da
darCes ojaxSi, socialuri pirobebis radikaluri cvlilebebi martoxela mSobels
moumzadebel mdgomareobaSi agdebs; igi srulfasovnad ver xelmZRvanelobs
Svilis aRzrdisa da ganviTarebis rTul process. qveyana unda uzrunvelyofdes
mSoblebisa da ojaxis sxva wevrebs saTanado informaciiT da mxardaWeriT,
raTa maT srulyofilad da adekvaturad upasuxon mozardis janmrTelobas,
socialur, ekonomikur da kulturul moTxovnilebebs da problemebs.
Zalian did gavlenas axdens mozardis ganviTarebaze eTnikuroba.
samwuxarod, yvela qveyanaSi erTnairad kargad ar aris daculi eTnikuri
umciresobis uflebebi. Sedegad sazogadoeba arasrulfasovnad viTardeba da
yalibdeba. naklebad ganviTarebuli mozardi, rasakvirvelia, arasrulfasovan
moqalaqed yalibdeba - mas gaaCnia arasrulfasovnebis kompleqsi, igi ver
iqneba Rirseuli damcveli am qveynisa, romelmac mas es kompleqsi gauCina.
miuxedavad imisa, rom arasrulfasovani ekonomikuri, kulturuli, socialuri
pirobebi Cagravs rogorc mamrobiTi, ise mdedrobiTi sqesis mozardebs, am
pirobebSi gogonebi xSirad ufro uares mdgomareobaSi imyofebian. msoflios
bevr regionSi gogonebi naklebad arian warmodgenilni yvela donis
27
saganmanaTleblo dawesebulebebSi. statistikurad, skolaSi swavlis drosac
gogonebis ganaTleba CamorCeba vajebisas. iuneskos monacemebiT, gogonebi
ufro metad arian CarTulni ojaxis sakiTxebis mogvarebisadmi, vidre saofise Tu
samrewvelo da misTana sakiTxebisadmi. ufro metic, SerCeul saskolo klasebSi
biWebi met yuradRebas iReben maswavleblebisagan, vidre gogonebi. cvens
qveyanaSi amisTana rames TiTqos ara aqvs adgili, magram fasiani swavlebis
SemoRebam dagvanaxva rom ojaxi vaJis saganaTleblo xarjebs ufro egueba.
sadReisod aRiarebulia, rom qalTa aRmzrdelobiTi, dasaqmebiTi,
janmrTelobisa da sxva moTxovnilebebis naklovaneba daRs asvams mTeli
sazogadoebis ganviTarebas. Sesabamisad, sazogadoebisaTvis sasicocxlo
aucileblobaa, rom mozardma qalebma SeZlon miiRon srulfasovani ganaTleba,
aRzrda, iyvnen dasaqmebulni - anu maT daukmayofildeT maTi sulieri da
materialuri moTxovnilebebi. maT unda SeeZloT ufro aqtiuri wevrebi iyvnen
sazogadoebaSi da ufro aqtiurad iTanamSromlon mamakacebTan.
mozardi Taobis normaluri ganviTarebisaTvis Zalian didi mniSvneloba
aqvs skolaSi dasaqmebas. dRevandel dRes, rodesac skolebSi sul ufro da ufro
meti axalgazrda swavlobs, izrdeba moswavleTa moTxovnilebebi da sxva
socialuri seqtorebi am moTxovnilebebs ver akmayofilebs. es safuZvelia
stresisaTvis. dausaqmebloba sakmaod xSirad aris xelSemwyobi faqtori
alkoholisaken da narkotikebisaken gadasaxrelad. arasakmarisi ganaTleba
avadmyofobisa da janmrTelobisaTvis saxifaTo qcevis mniSvnelovani risk-
faqtoria. igive SeiZleba iTqvas ltolvilebze, rac samwuxarod Cveni qveynis
mware sinamdvilea.
mniSvnelovan risk faqtorebs miekuTvneba, agreTve, rogorc mozardebis
zedmeti SromiT datvirTva da amiT skolis mocileba, aseve dausaqmoba –
umuSevroba, gansakuTrebiT ufrosi mozardebisa; socialuri perspeqtivis
SezRuduloba; mozardTa ganviTarebis, ganaTlebis, garTobisa da dasvenebis
saSualebebis uqonloba: mozards unda hqondes samoqmedo asparezi,
romelzedac igi Tavisi Tavis realizacias moaxdens. udidesi mniSvneloba
eniWeba saTemo organizaciebs, axalgazrdul organizaciebs, sulierebis
ganviTarebas. udidesia eklesiis roli.
janmrTeli ganviTareba gulsxmobs jandacvis sistemis funqciobas yvela
asakobrivi kohortisaTvis - bavSvobis, mozardobisa da mozrdilobis wlebSi.
jandacvis sistemam unda gamoavlinos mozardebSi janmrTelobis risk-faqtorebi,
uzrunvelyos efeqturi mkurnaloba, awarmoos qronikulad daavadebulTa
28
monitorireba, uzrunvelyos reabilitaciis procesebi. Zalian bevri qveyana
materialurad ver uzrunvelyofs jandacvis sistemis saTanado materialur
SesaZleblobebs. 1989 wlis msoflio jandacvis 42-e asambleis gadawvetilebis
Sesabamisad, saxelmwifoTa mTavrobebs unda gaaCndeT oficialurad
gancxadebuli jandacvis politika, romelic garkveviT gamoTqvams Tavis
valdebulebebs mozardTa mimarT, Tavis proeqtebsa da dagegmil qmedebebs
am valdebulebebis Sesasruleblad.
saWiroa arsebobdes da Tanmidevrulad da mizandasaxulad xorciel-
debodes Sesabamisi politika da kanonmdebloba mozardebsa da
axalgazrdebTan mimarTebaSi.

ZiriTadi daavadebebi da janmrTelobisTvis saxifaTo qceva

mozardobis periodSi
mozardobis periodi gansakuTrebuli periodia adamianis cxovrebaSi erTi
gansakuTrebuli mizezis gamoc - am asakSi xSirad safuZveli eyreba bevr
paTologiur process, romelic SemdgomSi mozrdil cxovrebaSi SeiZleba calkeul
daavadebad Camoyalibdes.
arteriuli hipertenzia, wylulovani daavadeba, revmatizmi, bronqebisa da
filtvebis zogierTi daavadeba, ai iseTi daavadebebis Zalze arasruli CamonaTvali.
eseni zRudaven pirovnebis SesaZleblobebs, mis vargisianobas zogierTi
profesiisaTvis, gavlenas axdenen qveynis Tavdacvisunarianobaze. pubertatobis
periodSi organizmi mgrZnobierea garemos arakeTilsaimedo faqtorebis mimarT,
organizmis adaptaciuri SesaZleblobebi arasrulfasovania. swored amitom
SeiZleba, rogorc zemoT iTqva, mieces am asakSi biZgi samomavlo paTologiuri
procesebis ganviTarebas. aseTi ram ufro im mozardebSia advili SesaZlebeli,
romlebsac ama Tu im daavadebis mimarT memkvidruli midrekileba gaaCniaT.
mozrdilobis asakSi formirdeba ama Tu im organoTa sistemis arCeviToba
sxavadasxva daavadebebis SedarebiT advilad aRmocenebisa da
ganviTarebisaTvis, klinikuri procesis TaviseburebebisaTvis, misi
gamosavlisaTvis.
mozardebSi qronikuli daavadebebi yovelTvis sworad da droze ar
diagnoscirdeba; ase magaliTad, kuW-nawlavis daavadebebi (wyluli, gastritebi)
araiSviaTad iwveven zrdaSi CamorCenas imis gamo, rom cila ar

29
gadamuSavdeba sworad, ris Sedegad iTrguneba anaboluri procesebi. igive
SeiZleba iTqvas qronikul hepatitebze da cirozebze (cximebsa da cximSi xsnadi
vitaminebis Sewova).
gul-sisxlZarRvTa sistemis daavadebebi-miokardiumis distrofia,
revmatizmi, mankebi da sxv. agreTve iwveven zrda-ganviTarebaSi CamorCenas
qsovilTa qronikuli hipoqsiis gamo.
sasunTqi sistemi araspecifikuri daavadebebi-ganviTarebis defeqtebi,
mukoviscidozi, bronqitebi, bronqoeqtazebi, sinusitebi iwveven Jangbadis
SeTvisebis darRvevas, cxviriT sunTqvis procesis darRvevas da agreTve
SeiZleba mizezi gaxdnen zrda-ganviTarebaSi CamorCenisa.
da bolos, iseTi endokrinuli daavadebebi, rogorebicaa dekompensirebuli
Saqriani diabetis formebi (moriakis sindromi), hipoTireozi, hipogonadizmi,
icenko-kuSingis sindromi, Tirkmelzeda jirkvlis qerqis mavirilizebeli hiperplazia
xSirad fizikuri da fsiqikuri CamorCenilobis mizezia.
mozardebSi avadobis maRali potencili, upiratesad, ganpirobebulia
Tambaqos moweviTa da arasasurveli orsulobis maRali maCvenebliT. Catarebuli
kvlevebia, romelTa saSualebiTac xerxdeba ganisazRvros mozardTa
janmrTelobis sferoSi ganxorcielebuli ama Tu im Carevis efeqtianoba. am
kvlevebiT TvalsaCinod demonstrirdeba, rom mozardebi, romlebsac sakuTar
Tavze cudi warmodgena aqvT an momavlisagan kargs arafers moelian, Taviani
qcevisa da cxovrebis araswori wesis gamo xSirad safrTxis winaSe dgebian.
isini, Cveulebriv, naklebad interesdebian sakuTari janmrTelobiT da arc rCevas
ekiTxebian vinmes amis Taobaze. mozardi pacientebis am jgufze Znelia
zemoqmedeba da naklebad savaraudoa, rom cxovrebis jansaRi wesis danergvis
strategia maTTan mimarTebaSi warmatebiTY ganxorcieldes. mozardebas
janmrTelobis Taobaze sakuTari Sexeduleba da mrwamsi aqvT, rac xSirad
sakmaod gansxvavdeba am sakiTxisadmi samedicino personalis
damokidebulebisagan. Meliville 1989 wels gamoqveynebul statiaSi amtkicebda,
rom mozardis fizikuri problemis ukan, ris gamoc igi eqims mimarTavs, uamravi
faruli problema da interesi imaleba. arsebobs sxva kvlevebic, romelTa
monacemebic miuTiTeben, rom qceviTi problemebi (uxasiaToba, sirTuleebi
skolaSi, komunikaciis gaZneleba da a.S) SesaZlebelia warmodgenili iyos
mozardebis 10-15%-Si. Meliville-ma TvalsaCinod warmoadgina faqtorebi,
romlebic, misi azriT, aferxeben mozardebze optimaluri zrunvis process, mag.

30
mozardebs uWirT komunikacia biurokratul StatTan an xSirad rTulia mozardebis
specifikuri problemebis, enisa (slengis) da kulturis gageba.
Catarebuli kvleviT gamovlinda, rom mozardebi ufro xSirad grZnoben Tavs
avad, vidre isini amis gamo eqims mimarTaven. mag. bevri mozardi wuxs
sakuTari wonisa da kanis mdgomareobis gamo, magram isini amis gamo
zogadi praqtikis eqimebs ar mimarTaven. londonSi Catarebuli erT-erTi
gamokiTxviT gamovlinda, rom sakiTxi, romelzedac mozardebs ufrosebTan surT
saubari sqesobrivi cxovrebis sferoa. isini amboben, rom ar aris aucilebeli es
adamiani zogadi praqtikis eqimi iyos. igive kvlevebiT aRmoCnda, rom
mozardebis didi nawili arajansaRi cxovrebis wesiT cxovrobs, 20% eweva
Tambaqos, 54% moixmars alkohols, 6% iyenebs aralegalur medikamentebs.
mozardTa janmrTelobis damkvidrebis uzrunvelsayofad aucilebelia vicodeT
ra aris am asakisaTvis specifikuri janmrTelobis problemebi.
saWmlis momnelebeli sistemis daavadebebis sixSire mozardebSi
aris daaxloebiT 100 SemTxveva 1000 mozardze. am sistemas erT-erTi
umTavresi roli miukuTvneba mozardis normaluri ganviTarebis
uzrunvelyofisaTvis.
mozardebSi saWmlis momnelebeli sistemis daavadebebis gavrcelebis
mizezebia: 1) memkvidreuli midrekileba (es faqtori gansakuTrebiT advilad
iCens xolme Tavs mozardobis periodSi); 2) am daavadebebis diagnostika
mozardobis periodSi xSirad gaZnelebulia mozardebis simorcxvis gamo; 3)
araswori kveba – kvebis araregularoba, sakvebis cudi ReWva da sxva.
anoreqsia nervoza.
es daavadeba xasiaTdeba sakuTari sxeulis formis gaukuRmarTebuli
SegrZnebiT, wonis daklebiT, simsuqnis SiSiT da qalebSi amenoeriT. daavadeba
ZiriTadad qalebSia gavrcelebuli. mamakacebSi mxolod SemTxvevaTa 5%-Si.
daavadeba uxSiresad prepubertatul asakSi iwyeba. gavrcelebulia igi upiratesad
mosaxleobis saSualo da maRal socialur-ekonomiuri fenebSi.
daavadeba SeiZleba xangrZlivad da agresiulad mimdinareobdes. aseT
SemTxvevevbSi sikvdilianobis procenti SeiZleba 20-mde avides.
daavadebis etiologia ucnobia. SesaZloa, daavadebis warmoSobaSi socialur
faqtorebs miuZRvodeT roli.
daavadebis ganviTarebis winamorbedad xSirad gvevlineba subieqtis didi
interesi sakuTari wonis mimarT (Tundac igi iyos gamxdari). aseTi mozardebi,
rogorc wesi, ewinaaRmdegebian mkurnalobas.
31
 anoreqsia araswori terminia, mada avadmyofs SerCenili aqvs, kaxeqsiis
ganviTarebamde. avadmyofi Zalian did interess iCens sxvadasxvanair
dietebisadmi. maT 50% axasiaTebs gaZlierebuli kveba, romelsac Tan sdevs
safaRaraTo da Sardmdeni wamlebis miReba. amenorea damaxasiaTebelia
yvela daavadebuli qalisaTvis. orive sqesis avadmyofebSi vlindeba
uinteresoba mowinaaRmdege sqesisadmi. klinikuri suraTi xasiaTdeba
agreTve: bradikardiiT, arteriuli hipotenziiT, RinRlovani TmianobiT an piriqiT –
hirsutizmiT, SeSupebebiT. damaxasiaTebelia, rom avadmyofebi kaxeqsiis
stadiaSic ki aqtiuroebi arian. xSiria depresia. avadmyofebi xSirad cruian
TavianTi kvebiTi Cvevebis Sesaxeb, xelovnurad gamowveuli pirRebinebis
Sesaxeb.
daavadebis dros aRwerilia mravalnairi endokrinuli darRveva –
maluTeinizebeli hormonis siWarbe, farisebri jirkvlis hormonebis nakleboba,
kortizolis produqciis siWarbe. yvelaze ufro sagangaSoa gul-sisxlZarRvTa
sistemisa da mineraluri cvlis darRvevebi: miokardiumis masis simcire, saknebis
patara zomebi, dabali wuTmoculoba, dehidratacia, sisxlSi K-is nakleboba.
avadmyofoba araiSviaTad mTavrdeba uecari sikvdiliT, xSirad parkuWovani
taqiariTmiebis gamo. zogierT pacients gamoxatuli aqvs gaxangrZlivebuli QT
intervali, xelisSemwyobi aseTi ariTmiebisaTvis.
warmatebuli mkuralobisaTvis aucilebelia hospitalizacia. mkurnaloba
Seicavs Semdeg komponentebs – antidepresantebis xmareba (xSirad), fsiqiatris
CarTva, kveba maRalkaloriuli sakvebiT.
bulimia nervoza
am daavadebis dros pacienti hkargavs kontrols sakvebis miRebaze,
periodulad iwyebs sakvebis miRebas uzomo raodenobiT, periodulad ki iwyebs
gantvirTvas pirsasaqmebeli da safaRarTo saSualebebiT. xSirad aseTi
avadmyofebi icaven mkacr dietas, raTa gamoasworon gadaWarbebuli kvebiT
gamowveuli simsuqne.
am avadmyofobis dros araiSviaTia kuWis dilatacia da ruptura. xelovnuri
pirRebineba xSirad iwvevs kbilis emalis gafuWebas, ezofagits, saylapavis
rupturas. pirRebineba SeiZleba mizezi gaxdes hipokalemiis. aRwerilia
SemTxveevbi ipekakuanis gadaWarbebuli miRebiT gamowveuli sikvdilis.
bulimiiT daavadebuli pacientebi ZiriTadad qalebia igive socialuri
wreebidan, rogorc anoreqsianebi. am ukanasknelebisagan gansxvavebiT,
bulimiani avadmyofebi ufro metad modian eqimebTan kontaqtze da ufro
32
advilad Tanxmdebian mkurnalobaze. bulimiaze eWvis mitana SeiZleba, Tu
pacienti did interess avlens wonis matebis mimarT, avlens wonis did
meryeobas, xmarobs safaRaraTo saSualebebs. am avadmyofebs xSirad aqvT
nakawrebi xelis mtevnebze (iwveven xelovnur pirRebinebas), eroziuli kbilis
emali. gaZlierebuli kvebis epizodebi xSirad inducirebulia fsiqologiuri
momentebiT, SeiZleba iyos mravaljer dReSi, xSirad – sxvebisagan farulad.
warmatebiT mkurnaloba gulisxmobs rogorc fsiqologiur, ise farmakologiur
mkurnalobas. avadmyofs xSirad esaWiroeba antidepresantebis micema
(Tundac depresia ar axasiaTebdes). mkurnalobis procesSi sasurvelia kvebis
specialistis CarTva.
simsuqne aris sxeulis wonis 20%-iT gaaWarbeba standartulze. ukiduresi
simsuqnis dros wonis siwarbe normis SeiZleba 100%-iT aWarbebdes.
mizezebi bolomde gasagebi ar aris. meqanizmi ki gasagebia – saWiroze
meti kaloriebis miReba. xelisSewmyobi faqtorebi: genetikuri, socialuri,
endokrinuli (kortikosteroidebis siWarbe  glikoneogenezi  insulinis gazrdili
saWiroeba  liponeogenezis stimulireba), fsiqologiuri problemebi, ganviTarebis
fqtorebi (cximovani ujredebis raodenobis, zomis an orives erTad mateba), Tavis
tvinis dazianeba.
simsuqniT daavadebulni xSirad socialurad izolirebulni arian. mkurnaloba
– dabalkaloriuli kveba, fsiqologiuri mxardaWera, fizikuri aqtivoba, qirurgiuli
Careva (lipoqsacia, gastreqtomia da sxva).
seqsologia, reproduqciuli janmrTeloba. siyvaruli da erotikuli
gancdebi mozardis cxovrebis eT-erTi umniSvnelovanesi mxarea. seqsualuri
gancdebi am periodSi Zalian daZabulia, seqsualuri aqtiurobas aSkarad adevs
eqsperimentulobis niSani, midis procesi Tavisi sakuTari SesaZleblobebisa da
TanatolebTan urTierTobebis mravali variantis gamocdis. didi daintereseba
sqesis sakiTxebiT ufro mozardi vaJebisTvisaa damaxasiaTebeli, vidre
gogonebisaTvis.
mozardTa asakSi seqsualuri aqtivobis yvelaze gavrcelebuli forma
masturbaciaa, igi normaluri aqtia am asakSi. xSirad igi iwyeba Tanatolebis
mibaZviT, zogjer SemTxveviTi aRmoCenaa sakuTar genitaliebTan Sexebisas.
didxans aqsiomad iTvleboda, rom gogonebSi es movlena ufro iSviaTia, vidre
vaJebSi. sadReisod SeiniSneba sqesobrivi gansxvavebebis nivelireba.
gansakuTrebul yuradRebas da specialistebis Carevas moiTxovs masturbaciis
iseTi formebi, romlebic Riad, sajarod keTdeba.
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 petingi – bevri axalgazrda wyvilisaTvis urTierTmizidva da erotikuli
gancdebi vlindeba naz sxeulismier kontaqtebSi (kocna, moxveva da sxva). es
erotikuli urTierTobebis erTgvari skolaa. amgvari kontaqtebi mozard gogonebSi
nakleb SiSsa da danaSaulis grZnobas iwveves, vidre sqesobrivi siaxlove,
vinaidan maT Tan ar sdevs sqesobrivad gadamdebi daavadebebi, adreuli
orsuloba.
seqsualuri urTierTobebis dasawyisi mozardobis asakSi uxSiresad ar aris
ganmtkicebuli saTanado fsiqologiuri da emociuri mowifulobiT. seqsi am asakSi
Taviseburi socialur-fsiqologiuri eqsperimentia. seqsualuri urTierTobebiT
emociur-fsiqologiuri dakmayofileba da orgastuli gantvirTva sinonimebi ar aris.
uxSires SemTxvevaSi, es miiRweva 20 wlis asakisaTvis.
mozardobis asakSi xSiria seqsualuri gadaxrebi (deviaciebi). maTi
mizezebi SeiZleba iyos fsiqikuri ganviTarebis darRvevebi, aRzrdis defeqtebi,
sxvadasxva Sxamebisa da toqsinebis moqmedeba (alkoholi, narkotikebi,
sxvadasxva Sxamebi, toqsinebi), mankieri socialuri garemo da sxva.
pubertatobis periodSi xSiria tranzitoruli homoseqsualuri kontaqtebi.
xSirad maT safuZvlad uZevT emociuri kontaqtebis moTxovnileba, interesi
TavianTi sasqeso organoebis mimarT, erToblivi seqsualuri garTobebi. am
asakSi araiSviaTia erotikuli sizmrebi, romlebSic subieqti partniorad Tavisive
sqesis subiets xedavs.
WeSmariti homoseqsualoba aris sqesobrivi kontaqtebi ZiriTadad an
mxoloddamxolod sakuTari sqesis individebTan. biWebSi WeSmariti
homoseqsualebis raodenoba 3-4%-ia, gogonebSi – 1-2%. sadReisod iTvleba,
rom amgvari atipia ar aris amoraluri an danaSaulebrivi movlena.
aRniSnul movlenaze zemoqmedebis specifikuri saSualeba ar arsebobs,
saWiroa zrunva farTo profilaqtikaze, aRzrdis swori normebis danergvaze.
aris SemTxvevbi, rodesac vaJi an gogona iqceva ara ise, rogorc es
damaxasiaTebelia misi sqesis TanatolebisaTvis (`qalaCuna~, `gogobiWa~). es
Zalian saTuTi sakiTxia da moiTxovs Zalian yuradRebian midgomas. zogjer
mozardSi qcevis amgvari tipi TandaTanobiT iSleba, zogSi – rCeba samudamod,
e.i. narCundeba mozrdilobaSic. aseTi darRvevisas mozardi mudmivad cdilobs
sapirispiro sqesis msgavsad moiqces mag. kontrastuli Cacmuloba. es biWebSi
ufro xSiria, vidre gogonebSi. aseTi kontrastuli Cacmulobis, homoseqsualizmisa
an Tanatolebis uaryofis gamo uamravi problema SeiZleba aRmocendes. aseT
SemTxvevebSi rekomendebulia mimarTva bavSvTa fsiqiatrTan, mkurnaloba
34
moicavs qceviTi modifikaciis programebs, individualur an ojaxur fsiqoTerapias.
sqesobrivi identifikaciis darRvevebi, jer-jerobiT cudadaa Seswavlili, ver
xerxdeba raime konkretuli etiologiuri faqtoris identificireba (endokrinuli,
qromosomuli an fsiqologiuri). ukiduresi varianti, rodesac saWiroa specialistis
radikaluri Careva, es aris sqesis sruli Secvlis survili. es transseqsualobaa. aseTi
individumebi itanjebian, rodesac maT epyrobian, rogorc im sqesis
warmomadgenlebs, romlebsac isini miuekuTvnebian da ara rogorc
sawinaaRmdegosas. msoflios statistikis mixedviT, transseqsualebi mamakacTa
Soris arian 1:100000-ze sixSiriT, qalebSi – 1:300000-ze. aRniSnuli paTologiuri
midrekileba yalibdeba 6 wlis asakidan da misi Secvla praqtikulad SeuZlebelia.
pubertatobis periodis ginekologiur problemebi. 18 wlamde mozardebSi
ginekologiur daavadebaTa sixSire sakmarisad maRalia. maTi struqtura aseTia:
menstrualuri funqciis darRvevebi – 46-65%, sqesobrivi momwifebis darRveva
19-25%, anTebiTi daavadebebi – 8-20%, sasqeso organoebis travmebi – 2-5%,
ganviTarebis anomaliebi – 0,7-1,2%, simsivneebi – 1,3-4,1%, sxva – 3-10%.
mozardebSi ginekologiuri daavadebebis dros vlindeba ramodenime
aTeuli simptomi. maT Cveulebriv, ase ajgufeben: TeTrad Sla, tkivili, sisxldena,
sqesobrivi momwifebis darRveva. TeTrad Sla SeiZleba iyos fiziologiuri da
paTologiuri. paTologiuri gamoirCeva siuxviT da aranormaluri formiT (Ciqrovani,
iqorozuli suniT, sisxlnarevi, qaviliani).
mizezebi: meqanikuri faqtorebi (mWidro, uxeSi tansacmeli, cxenosnoba,
masturbacia, sqesobrivi cxovrebis dawyeba), qimiuri saSualebebi,
damwvrobebi, avariebi, saTburis xmareba, alergia, infeqcia, endokrinuli
darRvevebi.
anTebiTi procesebi TeTrad Slis garda, vlindeba anTebiT, hiperemiiT,
nadebiT, qaviliT, usiamovno SegrZnebiT, kanis maceraciiT, eroziebiT, zogjer
sisxldeniT. zogjer procesSi CaerTveba ureTra da swori nawlavic.
TiTqmis yvela anTebiTi ginekologiuri daavadeba gadaitaneba sqesobrivi
gziT da es faqti yovelTvis gasaTvaliswinebelia.
paTologiuri TeTrad Slis mkurnaloba yovelTvis kompleqsuria – zogadi
gajansaReba, antibaqteriuli, madesensibilizebeli. saWiroa baqteriologiuri
analizi.
rac ufro axalgazrdaa pacienti, miT meti yuradReba eTmoba adgilobriv
mkurnalobas. igi zogjer sruliad sakmarsia gankurnebisaTvis.

35
 baqteriuli vaginozi. es diagnozi sul ufro xSirad daismeba praqtikosi
eqimebis mier. sadiagnozod didi mniSvneloba aqvs anamnezSi xangrZlivi
antibaqteriuli da qimioTerapiis faqts, radiaciis arsebobas, steroiduli hormonebis
gamoyenebas. diagnozisaTvis mniSvneloba aqvs rogorc Civilebs (uxvi
gamonadeni myrali suniT), simptomebis gamkveTreba tutovani garemos
Seqmnisas (tualetis sapnis gamoyenebisas), aseve saSos nacxSi gardnerelis
aRmoCenas.
mkurnaloba – mJave garemos Seqmna (2%-ni rZis mJaviT),
desensibilizacia, imunokoreqcia, adgilobrivi mkurnaloba sanTlebiT
(metronidazoli, folikulini, askorbinis mJava),.
profilaqtika – piradi higienis mkacri dacva, qronikuli infeqciebis kerebTan
brZola, araseptikuri rezistentobis gaZliereba (stafilokokuri anatoqsiniT,
solkoseriliT).
tkivilis sindromi. xasiaTdeba mucelSi diskomfortis arsebobiT. am
sindromis sixSire 50%-s aRwevs.
etiologiuri momentebi – memkvidruli midrekileba, anatomiur-fiziologiuri
faqtorebi (sakvercxeebis swrafi zrda, saSvilosnos zrda, myesebis daWimva,
Sinagani sasqeso organoebis sisxlZarRvovani qselis zrda, saSvilosnos
hiperantefleqsia); nervuli sistemis asakobrivi moumwifebloba, samizne
organoebis receptorebis arasrulfasovneba, damZimebuli perinataluri anamnezi
(asfiqsiaSi dabadeba, qronikuli infeqciuri procesebis arseboba, endokrinuli
paTologia), fsiqologiuri momentebi (konfliqtebi mSoblebTan, sasiyvarulo
gancdebi, stresebi). zogjer adgili aqvs agravaciis momentebs.
eqimma am sindromis arsebobisas ginekologiuri avadmyofi unda
miakuTvnos erT-erT jgufs Semdegidan:
I – mwvave tkivilebi mWidrod aris dakavSirebuli menstrualuri ciklis erT-
erT fazasTan (algomenorea, endometriozi, sakvercxeebis gagleja, ovulatoruli
sindromi);
II – araintensiuri tkivilebi, dakavSirebuli menstrualur ciklTan
(winamenstrualuri sindromi, fsiqogenuri tkivilebi, polikistozi);
III – intensiuri tkivilebi, romlebsac ara aqvT cikluri xasiaTi, sasqeso
organoebis travmuli, anTebiTi procesebi, qirurgiuli, infeqciuri, nevrologiuri
paTologia);
IV – qronikuli araintensiuri tkivilebi (tuberkulozi, sakvercxeebis qronikuli
anTebiTi procesebi, osteoqondrozi, orsuloba).
36
 diagnozi daismeba anamneziT, bimanualuri gasinjviT (60-65%-Si),
eqoskopiuri gamokvleviT, aucilebel SemTxvevaSi – laparaskopiiT. mkurnaloba –
etiologiuria. xSirad karg Sedegebs iZleva fexis cxeli abazanebi,
tkivilgamayuCebeli saSualebebi.
sisxldena sasqeso gzebidan aris fiziologiuri da arafiziologiuri. Tu
menarxes Camoyalibebisas (ZiriTadad, 12-14 ww) menstruaciis xangrZlivoba 2
dReze naklebi an 7 dReze metia, SeiZleba vivaraudoT paTologiis arseboba.
aseve paTologiuria menarxes Camoyalibebis procesSi menstruaciis 6 Tveze
metiT Sewyveta (meoradi amenorea).
sisxldenebi, dakavSirebuli menstruaciul ciklTan, Semdegia: iuvenileri,
ovulaciuri (mioburi, adenomiozuri, policistozuri) da koagulopaturi.
iuveniluri sisldenebi wmindad funqciuria. isini grZeldeba 7 dReze
metxans, xasiaTdeba mxubuqi anemizaciiT, Tumca SeiZleba arsebobdes
varianti, rodesac sisxldena ufro uxvia da iwvevs mniSvnelovan anemizacias.
mkurnaloba an ambulatoriulia (ara umetes 10 dRisa), an stacionaruli. Tu
dadasturdeba sisxldenis funqcionaluri buneba, mkurnalobis kompleqsSi Sedis
simptomuri saSualebebi, saSvilosnos SemkumSavi da sisxlis Sededebis
gamaZlierebeli saSualebebi. aseT SemTxvevebSi eridebian hormonaluri
preparatebis farTod xmarebas.
zogjer iqmneba aucilebloba saswrafo daxmarebis aRmoCenisaTvis. mis
kompleqsSi Sedis: 1) woliTi reJimi, 2) uxvad siTxis miReba, 3) Tbili saTburi
RviZlis areSi 45 wuTis ganmavlobaSi, 4) civi muclis qveda nawilSi, 10-15 wuTiT
yovel 40-60 wuTSi, 5) sisxldenis SemaCerebeli bunebrivi saSualebebi
(farsmandukis, WinWris, wylis wiwakis naxarSebi).
amenorea. pirveladia amenorea, rodesac igi ar aqvs 15 wlis asaks
miRweul qaliSvils, meoradi – rodesac igi 6 da meti TviT Seuwydeba qaliSvils,
romelsac igi 1-xel mainc hqonda. menarxe qaliSvilebs uCndebaT, rogorc wesi
araugvianes 3 Tvisa pubarxes dawyebidan. arsebobs sxeulis kritikuli masis
cneba – 40-45 kg. am maCveneblis miRwevisas menarxes gamoCena
kanonzomieria. pirveladi amenorea kargad gamoxatuli meoradi sasqeso
niSnebiT prognozulad ufro saimedoa, vidre cudad gamoxatuli niSnebiT. am
dros ufro savaraudoa, mniSvnelovani endokrinuli paTologiis arseboba.
diagnozis dasmisas afaseben meoradi sasqeso niSnebis gamoxatulebas,
Sinagani sasqeso organoebis ganviTarebas, SesaZlo heteroseqsualur niSnebs;
jer SeiZleba gamovlindes defeminizaciis niSnebi, Semdeg ki maT daematos
37
maskulinizaciis elementebi – hipertriqozi, hirsutizmi, kunTovani masis zrda,
xmis tembris dadableba da sxva.
didad informaciulia hormonaluri profilis gansazRvra dinamikaSi.
mkurnaloba – infeqciis kerebi sanacia, desensibilizacia, dezitoqsikacia
(enterosorbcia), vitaminoTerapia, hepatoproteqcia, biostimulatorebi,
refleqsoTerapia.
amenoreis 25% SemTxvevebSi saWiro xdeba paTologiis hormonaluri
koreqcia, es ginekologebis kompetenciaa. zogjer saWiroa fsiqologis
konsultacia.
sqesobrivi momwifebis darRvevebia sqesobrivi momwifebis CamorCena,
daCqareba, virilizacia, heteroseqsualoba. sqesobrivi ganviTarebis CamorCena
yvelaze xSiri darRvevaa gogonebSi. fizikuri ganviTareba, gamowveuli
somatotropuli hormoniT, unda Seefardebodes sqesobrivs, ganpirobebuls
gonadotropinebiT.
etiologia – ojaxur-konstituciuri mizezebi, qromosomuli daavadebebi,
centraluri nervuli sistemis paTologia.
mkurnaloba – TiTqmis iseTivea, rogorc amenoreis dros. Zalian
mniSvnelovania drois faqtori; Tu qaliSvils droze ar Cautarda efeqturi
mkurnaloba, misi menjis Zvlebi ar ganviTardeba saTanadod, Zvlovani asaki
kalendaruls CamorCeba 3-4 wliT da didxans SenarCundeba zogadi da
sqesobrivi infantalizmis suraTi.
maRaltanadoba – mozardebis eqimis praqtikaSi araiSviaTia maRali
gogonebi (175 sm-ze meti). am dros sasqeso ganviTareba an normaluria, an
ramdenadme CamorCenili.
mizezebi: marfanis sindromi, homocistinuria, Tireotoqsikozi, cerebraluri
gigantizmi, hipofizaruli gigantizmi, generalizebuli lipodistrofia, konstituciuri (es
ukanaskneli yvelaze xSiria). konstituciuri gigantizmis dros mkurnalobis
hormonaluri meTodebi Tu aris gamarTlebuli, mxolod drois mcire monakveTSi –
9-12 wlis asakSi. yovelTvis saWiroa fsiqologis konsultacia, vinaidan gogonebi
ganicdian Tavis simaRles.
kontracefcia mozardebisaTvis. mozardebisaTvis ojaxis dagegmarebaze
saubrisas eqimi unda Seexos Semdeg sakiTxebs: 1) SemTxveviTi orsulobis
profilaqtika, 2) sqesobrivad gadamdebi daavadebebis profilaqtika, 3) sakuTar
emociebsa da midrekilebebSi garkveva, 4) saswrafo kontracefcia, 5)
daorsulebis higienis wesebis codna.
38
 aRniSnul sakiTxebze saubari aucileblad moicavs iseT momentebs,
rogorebicaa prezervativis xmareba, daorsulebisaTvis `saxifaTo~ dReebis
gamoTvla, saSvilosnosSigniTa spiralis gamoyeneba, hormonaluri
kontraceptivebis gamoyeneba. mozards unda axsovdes saswrafo kontracefciis
aucileblobis Sesaxeb iseT situaciebSi, rogoricaa Zaladoba, prezervativis
mTlianobis darRveva.
oraluri hormonaluri kontracetivebis miReba unda Sewydes, Tu mozardi
uCivis: Tavis tkivilebs, mxedvelobisa da smenis moulodnel darRvevebs,
tkivilebs qvemo kidurebSi, moWeras gulmkerdSi, xvelas, Tu mas gamouvlinda:
hepatiti, epilepturi gulyrebi, arteriuli hipertenzia, orsuloba. kontraceptivebis
miReba unda Sewydes: 6 TviT adre daniSnul gegmiur operaciamde, travmis an
motexilobias gamo imobilizaciis dros.
mozardebisaTvis ginekologiuri daxmarebis organizacia
I etapi – am etapze mozardebs exmareba qalTa konsultacia, sameano
punqti, mozardTa poliklinikis sameTvalyureo kabineti, ojaxis eqimi. am etapis
amocanaa saswrafo daxmarebis aRmoCena metroragiis, algomenoreis,
mwvave muclis dros. amave etapze xdeba II da III etapze namkurnalevi
mozardebis dakvirveba da mkurnalobis CamTavreba.
II etapi – specializirebuli daxmareba, romelsac axorcielebs mean-
ginekologi. kabineti mozardebisaTvis Tavsdeba bavSvTa an mozardTa
poliklinikaSi, qalTa konsultaciaSi, ojaxis dagegmarebis centrSi an mozardTa
reproduqtologiur centrSi, pacientebi am kabinetebSi modian an TviTon, an I
etapis specialistebis mimarTviT.
III etapi – specializirebuli stacionari, konsultaciuri kabineti stacionarSi.
ojaxis eqimis, pediatris da mozardTa Terapevtis roli qaliSvilebis
reproduqciuli janmrTelobis dacvaSi
mozardTa reproduqciuli janmrTelobis dacva medicinis prioritetuli sakiTxi
unda iyos. am problemis ganxilva somaturi problemebisagan mowyvetiT
SeuZlebelia. amitom am sakiTxSi Zalian didia mozardTa Terapevtis roli.
sqesobrivi ganviTarebisa da menstruaciis darRvevebis mqone gogonebSi
srulyofilad unda iyos gamokvleuli eqstragenitaluri statusi – am kategoriis
gogonebze eqstragenitaluri darRvevebi gacilebiT ufro xSiria, vidre mTels
populaciaSi; xSiria farisebri jirkvlis, hipoTalamusis, hipofizis disfunqciebi,
tipiuria fsiqoemociuri sferos darRvevebi, fsiqosocialuri adaptaciuri darRvevebi,

39
xSiria imunuri procesebis disbalansi, infeqciuri procesebi. metaboluri
darRvevebis zogadi niSania endogenuri intoqsikacia.
aRniSnuli mdgomareobis dros somatur fons ganapirobebs Tirkmelebis,
saWmlis momnelebeli sistemis daavadebebi, vegetodistonia. es ukanaskneli
ama Tu im formiT yvela mozard gogonas uvlindeba. mWidro kavSiri arsebobs
vegetodistoniis simptomebsa (majebis cianozi, civi xelebi, distaluri da aqsilaruli
hiperhidrozi, gaZlierebuli demografizmi, gazrdili agznebadoba) da sqesobrivi
ganviTarebis siswrafes Soris. am tipis qaliSvilebisaTvis damaxasiaTebelia
fsiqoseqsualuri ganviTarebis disharmoniuloba da menstruaciuli ciklis myari
darRvevebi.
saWmlis momnelebeli sistemis darRvevebi praqtikulad yvela mozard
gogonas aqvs. Znelia xolme diferencirebuli diagnozis dasma abdominaluri
tkiviliTi sindromis dros. Zalian xSirad simptomebis provocireba xdeba
fsiqoemociuri daZabviT, dietis darRvevebiT. tipiuria spastikuri tkivilebis
aRmoceneba muclis Rrus organoebSi. zogjer avadmyofebi hispitalizacias
saWiroeben mwvave muclis diagnozis dasmis gamo.
menstruaciul ciklze uSualo gavlenas axdens kvebis Taviseburebebi;
sxeulis masis deficiti SeuRlebulia hipofizisa da sakvercxeebis hipofunqciasTan.
Sardsasqeso sistemis daavadebaTa struqturaSi xSiria ganviTarebis
anomaluri, nefroptozi, moZravi Tirkmeli, dismetaboluri nefropaTiebi,
kristaluriuli diaTezebi. am ukanasknels xels uwyob mozardTa hipermetabolizmi,
ganpirobebuli daCqarebuli fizikuri da sqesobrivi ganviTarebis procesebiT. igives
uwyobs xels hiperandrogenia, sakvercxeebis funqciis daqveiTeba. hipoTalamuri
sindromi.
saerTo jamSi, Tirkmelebis daavadebebi gogonebSi sakmaod
keTilTvisebianad mimdinareobs, funqcionaluri maCveneblebis daqveiTebis
gareSe.
anemiebi – rogorc wesi, dakavSirebulia rkinadeficitur mdgomareobebTan.
mozard organizmSi amisaTvis seriozuli winapirobebi arsebobs. magram, dRes
cxadia, rom mniSvneloba aqvs ara marto rkinis uaryofiT balanss, aramed
mniSvnelovan Zvrebs neiroendokrinul regulaciaSi, Tanmxleb somatur da
infeqciur daavadebebs.
gogonebSi rkinis dakargvas gansakuTrebiT uwyobs xels iseTi
mdgomareobebi, rogorebicaa: farisebri jirkvlisa da Tirkmelzeda jirkvlebis
hipofunqcia, hiperestrogenia. mkurnaloba unda iyos kompleqsuri – igi unda
40
warimarTos rogorc ZiriTadi avadmyofobis samkurnalod, ise anemiis
simptomebis gamosasworeblad rkinis preparatebiT.
hemoragiuli diaTezebi – praqtikulad am kategoriaSi ornairi avadmyofebia
moxvedrili; pirvel kategorias Seadgenen gogonebi, romlebsac hemoragiuli
diaTezis diagnozi dasmuli aqvT adreul bavSvobaSi da sisxldenebi emarTebaT
da uZlierdebaT menstruaciis dros. maTSi sisxldenebi sisxlis dabali Sededebis
unariT ki ar aris ganpirobebuli, aramed endokrinuli disfunqciiT da Tanmxlebi
somaturi daavadebebiT. hematologis Careva saWiro ar aris.
meore jgufi avadmyofebisa es is jgufia, romelsac diagnozi pirvelad
daesmeba iuveniluri metroragiis dros. rogorc wesi, es paTologiis ioli formebia.
koagulograma stabilurad normalizdeba ZiriTadi somaturi paTologiisa da
endokrinuli disfunqciis gamosworebis Semdeg.
SemaerTebeli qsovilis displazia – advilad dgindeba Semdegi
maCveneblebiT: 1) sayrden-mamoZravebeli aparatis sisuste (sqoliozi,
brtyelterfianoba, iuveniluri isteoqondrozi, saxsarSi moZraobis Warbi amplituda,
mxedvelobis darRvevebi);
2) Zvlebis ganviTarebis defeqtebi (gulmkerdis deformacia, Zvlebis
deformacia, kbilebis displaziuri zrda, goTuri sasa);
3) zedapiruli sisxlZarRvovani qseli, angioeqtaziebi, midrekileba venebis
varikozisaken, Tvalebisa da yurebis anomaliuri formebi da mdebareoba;
4) pigmenturi laqebi, kanis hiperelastikuroba, keloiduri nawiburebi
operaciis Semdeg.
aseTi gogonebis gamokvleviT dgindeba xolme Sinagani organoebis
anomaliebi, sisxlis ujredebis arasrulfasovneba.
somaturi da reproduqciuli janmrTelobis urTierTkavSiri – aRniSnuli orive
saxis darRvevebi viTardeba bavSvobis asakidan iseTi tipis gogonebSi,
romlebsac gadatanili aqvT samSobiaro travma, aqvT damZimebuli perinataluri
anamnezi, SemaerTebeli qsovilis Tandayolili arasrulfasovneba. aseT
mozardebze pubertatis asaki asrulebs mkveTri bunebrivi testis rols da
gamoavlens darRvevebs, romlebic manamde SeiZleba SeumCneveli iyo.
mozard gogonebs, rogorc wesi, mravlobiTi paTologia uvlindebaT; maTi
speqtri moicavs vegetodistinis komponentebs visceraluri sistemebis farTo
CarTviT klinikur suraTSi, metabolur darRvevebs da sxva. am gogonebSi
menstrualuri ciklis darRvevebi Sinagani organoebis darRvevebis markeris rols
asrulebs.
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 umravles SemTxvevebSi gogonebis saerTo mdgomareoba didad
darRveuli ar aris, amitom isini mas did yuradRebas ar aqceven. pubertatoba
xanmokle droiT avlens organizmis siRrmeSi arsebul paTologiur movlenebs,
Semdeg ki isini isev uCinardebian. amitom swored mozardebSi maqsimalurad
aqtiuri unda iyos diagnostika da mkurnaloba.
mkurnalobisa da reabilitaciis principebi – gansakuTrebiT efeqturia
individualuri samkurnalo kompleqsebi, minimaluri farmakoTerapiiT: cxovrebis
reJimis, mikrosocialuri garemos gamosworeba, fsiqoTerapia, moZraobis swori
reJimi, samkurnalo fizkultura, masaJi, hidroTerapia, manualuri Terapia,
refleqsoTerapia, enterosorbcia, bunebrivi samkurnalwamlo saSualebebi.
praqtika adasturebs, rom somaturi tonusis gaZlierebas Tan sdevs reproduqciuli
janmrTelobis mdgomarebis gaumjobesebac. Zalian didi mniSvneloba aqvs TviT
avadmyofi gogonebis aqtiur Cabmas samkurnalo procesSi. aucilebelia TviT
gogonas survili iyos janmrTeli.
mozardebSi orsulobis Terapiuli aspeqtebi. arasrulwlovanTa 80%-Si
wamyvania somaturi aspeqtebi. isini uxSiresad swored amitom mimarTaven
eqims. eqimma sworad unda Seafasos simptomatika da eWvi Seitanos arsebul
orsulobaze.
eqimTan misvlis erT-erTi ZiriTadi mizezia abdominaluri tkivilebi. isini
xSiria orsulobis dawyebidan 2-3 kviraSi. tkivilebs aqvT xolme Cxvletis xasiaTi,
aRmocendebian isini Wipis irgvliv, muclis qvemo nawilSi. gogonebs gamoxatuli
aqvT xolme intoqsikaciisa da dispersiis niSnebi.
vegetodistonia metnaklebad yvelas aqvs gamoxatuli; yvelaze ufro xSiria
respiratoruli diskomforti, kardialgiebi, Tavis tkivili da Tavbrusxvevebi,
hemodinamikuri – sisxlmimoqcevis hiperkinetikuri tipi, sisxlZarRvovani tonusis
daqveiTeba. xSiria miokardiumis distrofiis sxvadasxva formebi, Tu mozardis
Terapevtma droze ver miitana eWvi orsulobis arsebobaSi, saTanado
daxmarebis aRmoCena gviandeba da es SeiZleba sabediswero aRmoCndes
gogonasaTvis. orsulobaze eWvi unda mitanil iqnas, rodesac adgili aqvs Semdeg
niSnebs: tkivils sarZeve jirkvlebSi, madis momatebas (zrdis shurtTan
daukavSireblad), tkivils mucelSi Wipis irgvlic da qvemo nawilSi, Tviuris
dagvianebas. aRsaniSnavia, rom gadidebuli saSvilosno ar isinjeba 10 kviraze
adre. mniSvnelovania isic, rom bevrs aqvs xolme mcire sisxnarevi gamonadeni;
menstruaciis vadebis Sesatyvisi. es abnevs rogorc orsul mozards, ise eqims.

42
 somaturi da reproduqciuli sferoebis mravalmxrivi kavSirebis
gaTvaliswinebiT, aucilebelia mkurnalobis kompleqsuri midgomis organizeba.
aucilebelia gogonebis dispanzerizaciis srulyofili mogvareba, mozardTa
eqimebisa da ginekologebis urTierTkavSiri.
andrologiuri problemebi
reproduqciuli janmrTelobis dacva exeba ara marto gogonebs, aramed
vaJebsac. maTi SigniTa da gareTa sasqeso organoebi formirdeba embrionalur
periodSi, viTardeba da yalibdeba pubertatobis periodSi, sabolood
ganviTarebulia 18-20 wlis asakSi. normaluri mamakacuri genotipi
ganisazRvreba genetikuri nakrebiT, romelic Sedgeba 44 autosomuri da 2
sasqeso (X da Y) qromosomisagan. Canasaxis saTesle jirkvali Zalian adre
iqceva aqtiur endrokrinul organod da mis mier gamomuSavebuli androgenebi
ayalibeben SigniTa da gareTa sasqeso organoebs. dabadebis dRidan sqesi
ganpirobebulia gareTa sasqeso organoebis aRnagobiT, ris Semdeg
ganmtkicdeba fsiqoafeqturi seqsualizaciiT sicocxlis pirveli 18-30 TveSi da
Semdgom – mTeli cxovrebis manZilze.
sasqeso organoebis saboloo Camoyalibeba mamakacebSi xdeba
sqesobrivi momwifebis periodSi. maTi sididis Sesafaseblad SeiZleba
testometrisa an orqidometris gamoyeneba. gasaTvaliswinebelia sxeulis
proporciebis cvlilebebi, boqvenis gaTmianeba. sqesobrivi ganviTarebis 2 wliT
dagvianeba ukve sayuradReboa hipogonadizmze saeWvod. sqesobrivi
momwifeba SeiZleba Seanelos samSobiaro travmam, mZime infeqciebma,
toqsikozebma, qala-tvinis travmebma, Sinagani organoebis daavadebebma.
mozardebi gamokvleuli unda iqnan endokrinologiurad, sasqeso qromatinze,
testosteronze, prolaqtinze, 17-ketosteroidebze, sxva hormonebze. saWiroa
hormonaluri profilis gansazRvra.
saTesle jirkvlebis anomaliebi
kriptorqizmi – erTi an orive saTesle jirkvlis ararseboba saTesle parkSi.
igi aqvs axalSobilTa 10-20%-s, 1 wlis asakSi biWebis 2-3% da pubertatobis
asakSi – 1%-s. calmxrivi kriptorqizmis dros garkveuli mniSvneloba eniWeba
sazardulis arxis arasrulfasovnebas. ormxrivis dros kriptorqizmi SeuRlebulia
saTesle jirkvlebis disgeneziasan, amitom mozardebis nawili, jirkvlebis saTesle
parkSi Camotanis Semdegac, rCeba arasrulfasovani. aRwerilia ojaxuri
kriptorqizmi – misi arseboba mamakacebis ramodenime TaobaSi, amitom
eqimebma yuradReba unda miaqcion avadmyofi vaJebis ojaxebs.
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 mkurnaloba ZiriTadad qirurgiulia (orqipeqsia). Careva sasurvelia
Sesruldes 4-5 wlis asakSi, biWis skolaSi misvlamde. amiT unayofoba Tavidan
aicileba 80%-Si calmxrivi kriptorqizmis dros da 30%-Si ormxrivis dros.
poliorqizmi – orze meti saTesle jirkvlis arseboba - iSviaTi anomaliaa.
damatebiTi jirkvlebi uxSiresad muclis RruSia isini degeneraciulad
gadagvardebian da SeiZleba stimuli miscen avTvisebian process. naCvenebia
maTi operaciuli mocileba.
sinorqidizmi – jirkvlebis iSviaTi muclisSigniTa Sexorceba. amave dros
isini hormonalurad aqtiurebi arian. monorqizmi – 1 saTesle jirkvlis arseboba. Tu
igi amave dros ar CaeSva parkSi, viTardeba hipogonadizmi.
anorqizmi – jirkvlebis ararseboba. imis gamo, rom androgenebi ar
warmoiqmneba, sasqeso organoebi viTardeba qaluri tipiT. anorqizmis dros
tardeba SenacvlebiTi Terapia sasqeso hormonebiT.
hermafroditizmi – arsebobs rogorc WeSmariti, ise cru. WeSmariti
hermafroditizmis dros saTesle jirkvlebSi viTardeba rogorc saTesle jirkvlis, ise
sakvercxis qsovili. gareTa sasqeso organoebs aqvT ormagi Seneba. viTardeba
sarZeve jirkvlebi. avadmyofebis sqesi fsiqiurad ganpirobebulia aRzrdiT da ara
garegani saqeso organoebis SenebiT. naCvenebia sakoreqcio operaciuli
mkurnaloba da Terapia hormonebiT.
cru hermafroditizmis dros saTesle jirkvlebi arsebobs, magram gareTa
sasqeso organoebi viTardeba qaluri an interseqsualuri tipiT. am paTologiis
mizezebia hormonaluri darRvevebi orsulobis dros, toqsoplazmozi,
intoqsikaciebi.
mafeminizebeli saTesle jirkvlebis sindromi – am dros periferiuli
qsovilebi ugrZnobebi arian androgenebis mimarT: gareTa sasqeso organoebi
viTardeba qaluri tipiT. saTesle jirkvlebi qmnian androgenebis normalur da
estrogenebis Warb raodenobas. daavadeba ganpirobebulia genetikurad,
gadaecema janmrTeli qalebis mier recesiuli geniT.
mkurnaloba – mafeminizirebeli hormonaluri Terapia.
klainfelteris sindromi – damatebiTi X qromosomis arseboba kariotipSi.
daavadeba xasiaTdeba Warbi simaRliT, sasqeso organoebis arasakmao
ganviTarebiT, evnuqoidizmiT, ginekomastiiT, fsiqiuri arasakmao ganviTarebiT.
mkurnaloba – androgenebiT Terapia, vitaminoTerapia, ginekomastiis
qirurgiuli mkurnaloba. gansakuTrebiT mniSvnelovania hormonoTerapia
pubertatobis dros.
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 saSarde arxis anomaliebi
hipospadia – ureTris saboloo ganuviTarebloba darCenili nawilis
SemaerTi qsoviliT SecvliT. amis Sedegad ureTris gareTa xvreli SeiZleba
arsebobdes gvirgvinovan arxSi, penisis ukana mxares, skrotumze an SorisSi.
mkurnaloba qirurgiulia da warmoebs 2 etapad: I etapi – 1-2 wlis asakSi
(penisis gasworeba), II etapi – 6-13 w. asakSi (ureTris darCenili nawilis
Seqmna).
epispadia – ureTris defeqti, romelic gamoixateba misi zeda kedlis srul
an nawilobriv ararsebobaSi. daavadeba SeuRlebulia kriptorqizmTan,
saTesleebis hipoplaziasTan, saTesle parkis ganuviTareblobasTan.
mkurnaloba – asos Tavis epispadia mkurnalobas ar saWiroebs. asos
sxeulis da totaluri epispadiis dros operaciuli Careva aucilebelia.
penisis ganviTarebis anomaliebi
fimozi – CuCis Seviwroveba. mkurnaloba – operaciuli.
parafimozi – asos Tavis gaWedva, ukan gadaweul CuCis rgolSi.
parafimozi xSirad fimozis garTulebaa. mkurnaloba operaciulia.
asos lagamis simokle – xels uSlis asos Tavis gamoTavisuflebas
prepuciuli parkidan. mkurnaloba – operaciuli.
sasqeso organoebis anTebiTi daavadebebi
orqiti – mizezebi SeiZleba iyos sxvadasxva infeqciuri procesebi.
maprovocirebeli momenti SeiZleba gaxdes saTesle jirkvlis travma.
diagnozis dasmisas saWiroa araspecifikuri epadidimiti diferencirdes
tuberkulozuri, sifilituri, brucelozuri orqitisagan da simsivnisagan.
mkurnaloba – antiinfeqciuri preparatebiT, abscesis SemTxvevaSi –
qirurgiuli Careva.
epididimiti – saTesle jirkvlis danamatebis anTeba sasqeso organoebis
erT-erTi yvelaze xSiri daavadeba seqsualuri aqtiurobis periodSi. etiologiuri
momentebi – infeqcia, ureTris striqtura, fimozi, gaciveba, travma.
mkurnaloba – antibiotikebi, analgetikebi, madesensibilizebeli
saSualebebi, suspenzoriumis tareba. abscedirebis SemTxvevaSi – qirurgiuli
mkurnaloba.
balaniti da balanopostiti _ CuCis SigniTa zedapiris anTeba, SigniTa
zedapiris da asos Tavis anTeba. xSirad es paTologiuri procesebi fimozis dros
viTardeba, maT xels uwyobs hiradi higienis normebis Seusrulebloba _ smegmis
daSlis produqtebis dagroveba, maTi meSveobiT anTebiTi procesis stimulireba.
45
procesis mwvave stadiaSi Cacxromis gareSe igi SeiZleba qronikul stadiaSi
gadavides. am ukanasknelis dros SeiZleba nawiburebisa da Sexorcebebis
gaCena. mkurnaloba _ CuCisa da asos Tavis zedmiwevniTi tualeti kaliumis
permanganatis Tbilis xsnariT, furaciliniT. saWiroebisas tetraciklinis,
prednizolonis malamos xmareba yoveli mobanvis Semdeg.
saTesle bagirakis, saTesle jirkvlisa da danamtebis sakidis
gadagrexa.es paTologia bavSvebisa da Wabukebisaa. dazianeba calmxrivia,
ormxrivoba uiSviaTesia. mkurnalobis gareSe es daavadeba SeiZleba saTesle
jirkvlis nekroziTa da atrofiiT damTavrdes. daavadebis anatomiuri winapirobaa
im myesis ararseboba, romelic saTesle jirkvals parkis fuZesTan erTebs. aseTi
anomalia xSirad Tan sdevs kriptorqizms, saTesle jirkvlis parkSi gvian Casvlas.
gadagrexis uSualo mizezia sqesobrivi agzneba, travma, fizikuri gadaZabva.
paTologiis klinikuri gamoxatuleba xSirad aris mwvave tkiviliTi dasawyisi, rasac
Semdeg cxeleba emateba. jirkvlis mucelSigniT yofnis SemTxvevaSi suraTi
mwvave mucels gvagonebs, sazardulis arxSi yofnisas _ tkivili da SeSupeba
xSirad aqaa, parkSi yofnisas _ jirkvali mTlianadaa gadidebuli. mkurnaloba _
saswrafo hospitalizacia da qirurgiuli Careva. operaciis mizania gadagrexili
bagirakis gasworeba, jirkvlis fiqsacia da misi sicocxlisunarianobis dadastureba.
varikocele. 15-16 wlis WabukebSi varikocele 10-12% SemTxvevaSi
gvxdeba. procesi upiratesad marcxenamxrivia, anatomiuri Taviseburebebis
gamo: marcxena saTesle jirkvlis vena swori kuTxiT uerTdeba marcxena Tirmklis
venas, marjvena vena ki _ maxvili kuTxis qveS _ qvemo Rru venas. saTesle
jirkvlebis venebSi wnevis momatebas xels uwyobs Tirkmlebis venur sistemaSi
an qemo Rru venis sistemaSi wnevis mateba. varikoceles stadiebia I – dan III. I
SemTxvevaSi igi mxolod palpaciiT mJRavndeba, II da III stadiebi ki ukve
TvaliTac Cans. varikoceles mizezi SeiZleba iyos retroperitonealurad arsebuli
simsivnidan metastazi. mkurnaloba _ qirurgiuli.

mozardobis sxva samedicino problemebi

problemebi, romlebic vlindeba mozardobaSi, xSirad Caisaxeba bavSvobis

asakSi. infeqciuri procesebisa da cudi kvebis Sedegebi xSirad did tvirTad
awveba mozardebs. isini cudad arian momzadebulni socialuri

46
urTierTobebisaTvis. mozardebSi xSiria iseTi paTologiuri procesebis dawyeba an
gamomJRavneba, rogorebicaa tuberkulozi, guli revmatuli daavadeba, iuveniluri
diabeti. mozardobis dros SeiZleba gamovlindes mxedvelobis, smenis,
metyvelebis defeqtebi, romlebsac safuZveli Caeyara, mag. mSobiarobisSida
travmis dros. mozardobaSi xSirad axali ZaliT vlindeba iseTi daavadebebi,
romlebic genetikurad aris ganpirobebuli _ hemoglobinopaTiebi, hemofilia,
kisturi fibrozi.
didi problemebs uqmnis mozardebs da, saerTod, sazogadoebas is
paTologiuri mdgomarebebi, romlebic mozardebis araswori saqcielis mizeziT
aRmocendeba: alkoholizmi, narkomania, sqesobrivad gadamdebi daavadebebi,
daugegmavi orsuloba, travmatizmi. farTod aris gavrcelebuli mozardebSi
neirocirkulatoruli distonia, axalgazrduli hipertenzia, sayrden-mamoZravebeli
aparatis dazianebebi.

qronikuli daavadebebi

tradiciulad, mozardebis eqimebi met-naklebi warmatebiT mkurnaloben

mwvave paTologias. qronikuli daavadebebis mkurnaloba SedarebiT
naklebefeqturia. daavadebaTa qronikuli mimdinareoba did daRs asvams
mozardis fsiqikas da amdenad, aq eqimis winaSe dgeba fsiqikuri janmrTelobis
SenarCunebis problema. fsiqiuri wonasworobis darRveva qronikuli daavadebis
dros mniSvnelovnad amZimebs prognozs. meore problema, romelic xSirad
unda gadawyvitos mozardis eqimma, aris mozardis sarisko yofaqceva
(sqesobrivi urTierTobebis sfero, narkotikebis gamoyeneba), romelic
daavadebaTa qronizaciis didad xelisSemwyobi faqtoria.
epidemiologiuri monacemebis safuZvelze SeiZleba iTqvas, rom dRes
iseve, rogorc Zvelad, bavSvebis garkveuli raodenoba ibadeba an avaddeba
iseTi daavadebebiT, rogorebicaa: kisturi fibrozi, gulis Tandayolili mankebi,
namglisebujredovani anemia, Saqriani diabeti, qronikuli nefriti, hemofilia,
epilefsia, cerebraluri dambla, leikemia, gulis parkuWTaSorisi defeqti. bevri
qronikuli daavadebis prognozi dramatikulad Seicvala; es gamowveulia didi
warmatebebiT qirurgiaSi, transplantologiaSi, qemoTerapiaSi, antibiotikoTe-
rapiaSi. Sedegad amisa, bevri qronikuli daavadebiT Sepyrobili bavSvi aRar aris
ganwiruli, mas SeiZleba imedi hqondes ara marto gadarCenis, aramed
47
metnaklebad xangrZlivi da zogjer praqtikulad jansaRi sicocxlis. saqme iqamdec
ki midis, rom horizontze Cans perspeqtivebi spinaluri avadmyofebisaTvis
(zurgis tvinis travmuli dazianebis mqoneni), bevri usinaTlo avadmyofTaTvis da
a. S.
rogorc zemoT iTqva, qronikuli daavadebebis mkurnalobaSi did
problemebs qmnis pacientis fsiqikuri mdgomareoba. statistika uCvenebs, rom
mozardebi, romlebsac hqondaT esa Tu is qronikuli paTologia, ufro Znelad
wyvetdnen saskolo problemebs. am faqtebis logikuri gagrZelebaa is faqti, rom
rac ufro mZimed mimdinareobs qronikuli paTologiuri procesi, miT ufro Znelad
wyveten mozardebi maT winaSe mdgar fsiqosocialur problemebs. qronikulad
moavade mozardebidan fsiqikuri problemebi im axalgazrdebs ufro aqvT,
romlebic dainvalidebulni arian am avadmyofobis Sedegad, xolo Tu invalidobas
adgili ar aqvs, am qronikuli avadmyofebis mentaluri statusi praqtikulad
normaluria. aRsaniSnavia, rom mamrobiTi sqesis qronikulad moavade
mozardebi ufro advilad ziandebian fsiqiurad, vidre mozardi gogonebi.
mozardebisTvis damaxasiaTebeli da xSiri daavadebebia, agreTve, -
sportuli travma, ubeduri SemTxveva, akne, Zval-saxsrovani sistemis
daavadebebi. cxadia, am asakisTvisac problemaa gripi da mwvave respiratoruli
infeqciebi; bronquli asTma; Saqriani diabeti da sxva damainvalidebeli
daavadebebi.

fsiqikuri janmrTeloba

mozardebi Zalian mgrZnobiareni arian sxvadasxva saxis stresis mimarT,

romelic safuZvels uyris mentalur destabilizacias. mozardebi ara marto fizikurad
da sulierad jansaRebi unda gaizardon da ganviTardnen, aramed kidec unda
gaumklavdnen im viTarebebs, romlebsac Tanamedrove sazogadoeba qmnis. es
sazogadoeba dRes xasiaTdeba ojaxuri struqturebis dasustebiT, swrafi
urbanizaciiT, ukiduresi konkurenciiT cxovrebis yvela ubanze da yvela aspeqtSi,
alkoholiani sasmelebisa da narkotikuli saSualebebis SemoWriT yoveldRiur
cxovrebaSi, depresiuli mdgomareobebis siuxviT.
mentaluri problemebis umravlesoba sworad mozardobaSi gamovlindeba.
Tu isini arasworad inkurneba, es tvirTad awveba mozards da mTel
sazogadoebas. amitom mozardis mkurnal eqims didi pasuxismgebloba akisria
48
rogorc mozardis, ise mTeli sazogadoebis winaSe. bevri didi fsiqikuri problema –
sulieri daavadebebi – fsiqozebi, Sizofrenia, maniakaluri mdgomareobebi an
iwyeba, an vlindeba pirvelad mozardobis asakSi. mozardebis aranormaluri
saqcieli – TviTmkvleloba, alkoholisadmi an narkotikebisadmi midrekileba –
xSirad arajansaRi mentaluri statusis gamovlinebaa, socialur garemosTan
araadeqvaturi adaptaciis niSania. eqimma unda gaiTvaliswinos, rom mozardebi
zogierTi socialuri jgufebidan ufro mgrZnobiareni arian stresebisa da mentaluri
statusis darRvevebisadmi: rasuli, religiuri da eTnikuri umciresobidan, uaxloesi
axlobelis damkargavi, qronikuli somaturi daavadebiT Sepyrobili, fizikuri,
emociuri, an seqsualuri zewolis qveS myofi, usaxlkaro, dausaqmebeli da Raribi,
orsuli mozardi an mozardi mSoblebi.
mozardebSi sakmaod xSiria seqsualuri agresia – vaJebi iswrafian
maqsimalurad gamoavlinon TavianTi mamakacoba, gogonebma – qaloba.
sazogadoebriv azrovnebaSi damkvidrebulia azri, rom mamakacTa
umravlesobaSi seqsualuri grZnobebi Seicavs agresiulobis elements,
kultivirdeba `WeSmariti mamakacis~ stereotipi. uxSiresad sqesobrivi agresia
mozrdebSi vlndeba cinikuri qceviT, laparakiT, Tavisi asakis gogonebis uxeSi
erotikuli SexebiT. rogorc gviCvenebs praqtika, WeSmariti Zaladobis Casadenad
damatebiTi pirobebia saWiroa, axalgazrda moZaladeebSi ar aris ganviTarebuli
da Camoyalibebuli Sexedulebebi qalis Rirsebaze, mis Tavisuflebaze, pirovnul
Seuxeblobaze. ukiduresi egoizmi, individualizmi, ukulturoba pirobas qmnis
imisaTvis, rom urTierToba mopirdapire sqesTan ganixileba wmindad fiziologiuri,
cxoveluri poziciebidan. aseT pirovnebaSi alkoholi xSirad stimulatoris da
provokatoris rols asrulebs.
yovel ZaladobaSi monawilebs 3 komponenti: Zalaufleba, mrisxaneba da
seqsualoba. moZaladisaTvis Zaladobis aqti saSualebas iZleva Secvalos
sakuTari TviTSefaseba, partniori da misi tanjva moZaladisaTvis sakuTari Tavis
dabali Sefasebis kompensaciaa. rodesac moZalade xedavs sxvis tanjvas, igi
TiTqos Tavisi tanjvisagan Tavisufldeba. Zaladobisdmi midrekilebas avlenen,
ZiriTada, feTqebadi xasiaTis mozardebi, gazrdilebi socialurad naklovan ojaxur
garemoSi. seqsualuri agresiis 2 forma arsebobs – agresiul-sadisturi da
seqsualur-sadisturi. pirveli gamoxatavs pirovnuli reagirebis Taviseburebebs
konfliqtur situaciebSi. moqcevis aseTi stili yalibdeba sakmaod adre,
bavSvobaSi. igi Sedegia im mikrosocialur garemoSi yofnisa, sadac Zaladoba
qcevis normaa. aseT pirovnebebSi agresia xdeba TviTmizani da moZalades
49
specifikur siamovnebas aniWebs. sqesobrivi momwifebis paralelurad moqcevis
agresiuli xasiaTi gadaitaneba seqsualur sferoSi. meore SemTxvevaSi
paTologiuri saqcieli vlindeba mxolod mozardobis periodSi, Tumca ukve
bavSvobaSi SeiniSneba tendencia cxovelebis wvalebiT, dedis TeTreulis recxvis,
dedasTan erTad loginSi wolis da sxva, pubertati aseT mozardebSi
mimdinareobs mkveTri hiperseqsualobiT, agresiuloba Serwymulia
gaukuRmarTebul seqsualur dakmayofilebasTan, iqmneba agresiulobisa da
seqsualuri reaqciebis mtkice kavSiri. Cveulebrivi seqsualuri qceva
moZaladisaTvis ar aris mimzidveli, masSi sadisturi komponenti sWarbobs.
seqsualur agresiis msxverpli iSviaTad acxadebs amis Sesaxeb.
popsttravmuli stresuli darRvevebi praqtikulad yovel dazaralebuls uviTardeba.
esenia nevrotuli reaqciebi agreTve asTeniuri, depresiuli mdgomareobebi, Ramis
koSmarebi, Zalis darRveevbi, akviatebuli azrebi. bevr gogonas uviTardeba
sakuTari Tavis mimarT zizRisa da danaSaulis grZnoba.
Zaladobis SemTxveva, zogjer, pirdapir vlindeba, zogjer ki pacienti
sxvadasxva simptomebs warmoadgens, romelTa ukan es arasasurveli movlena
imaleba (igive SeiZleba iTqvas fizikur, Zaladobaze, daudevar
damokidebulebasa da emociur Zaladobazec, magram sqesobrivi Zaladobis
gamoaSkaraveba mainc yvelaze rTulia). yvela eqimi unda icnobdes adgilobriv
kanonmdeblobas imis Taobaze, Tu rogor unda moiqces Zaladobis faqtis
gamoaSkaravebis SemTxvevaSi. xSirad, ojaxis eqimi pirveli adamiania, romelic
amis Sesaxeb iRebs informacias, amdenad, igi yovelTvis mzad unda iyos
daicvas mozardis interesebi da daukavSirdes saTanado organoebs amis
uzrunvelsayofad.
upirveles yovlisa, eqimma mozards unda auxsnas, rom Zaladobis
Taobaze mas konfidencialobis dacva ar SeuZlia da valdebulia es informacia
sxva samedicino profesionalebs an bavSvTa dacvis socialur da
samarTaldamcav organoebs gauziaros. Zaladobis faqtis gamovlenis
dasafiqsireblad erT-erTi saukeTeso gzaa gamocdili specialistis mier mozardTan
Catarebuli saubris videoCanaweri. Tu Zaladobis faqtis aRmoCena ojaxis eqimis
mier moxda, aucilebelia saubris detaluri (sityva-sityviT) Canaweris Sesruleba -
Tu SesaZlebelia, sasurvelia zustad Caiweros SekiTxva, romelic eqimma
mozards dausva da pasuxi, romelic miiRo.

50
 sqesobrivi Zaladobis arapirdapir gamovlinebas SesaZloa warmoadgendes
sxvadasxvagvari simptomi, an seqsualizebuli qceva, sqesobrivi gziT gadamdebi
daavadeba, an orsuloba.
Zaladobis SemTxvevebis marTva, upirveles yovlisa, mozardis
usafrTxoebis uzrunvelyofas gulisxmobs, Semdeg unda moxdes ZaladobiT
gamowveul da mis Tanxleb simptomebze yuradRebis gamaxvileba.
zogjer aucilebeli xdeba am procesSi bavSvTa fsiqiatris monawileoba. es
maSin xdeba, Tu bavSvi an mozardi cdilobs damalos momxdari an ojaxis
eqimTan vizitis droisaTvis Zaladobis niSnebi TvalsaCino ar aris an eqimi
aRmoaCens saeWvo niSnebs da Tvlis, rom aucilebelia Semdgomi Sefaseba.
bavSvTa fsiqiatris monawileoba aucilebeli xdeba maSinac, rodesac sasamarTlo
procesis damTavrebis Semdeg bavSvi kvlav daTrgunulia, stresis zemoqmedebis
qveSaa da simptomebs warmoadgens. SesaZloa saWiro gaxdes individualuri,
ojaxuri an jgufuri fsiqoTerapia.
agresiuli da sadisturi tendenciebis sarkuli anareklia autoagresia da
mazoxizmi. aseTi tipis movlena sakmaod farTod aris gavrcelebuli mozardebs
Soris.

depresia

6-11 wlis asakobriv jgufSi depresiiT daavadebianoba 0,4-dan 2,5%-mde

meryeobs da 0,4-dan 6,4%-ia 12-dan 19 wlmade asakSi (Fleming and Offord,
1990). zogadad, mozardis asakis matebasTan erTad depresiiT daavadebianobis
maCvenebeli izrdeba.
mozardebSi depresia iseTive simptomebiT xasiaTdeba, rogorc
mozrdilebSi, Tumca dominirebs guneba-ganwyobis daqveiTeba (rac, sul mcire,
ori kvira grZeldeba), daRliloba, cxovrebis xalisisa da interesis dakargva. amas
SesaZloa Tan axldes iseTi simptomebi, rogoricaa Zilis darRveva, madis
dakargva, koncentraciis unaris gauareseba amis gamo warumatebloba skolaSi,
danaSaulis SegrZneba, sakuTar TavSi rwmenis dakargva, gaRizianebadoba,
somaturi Civilebi, socialuri ganyeneba, suicidaluri azrebi an fiqri sikvdilze.
depresia bavSvobis asakSi xSirad, tipiuri Wirisuflobis gamovlinebaa an es
SeiZleba qronikuli daavadebis, sxva fsiqikuri problemis fonze aRmocendes.
depresia xSiria bavSvebSi, romelTa mSoblebsac afeqturi aSliloba aReniSnebaT.

51
 mozardTa depresiis mkurnalobaSi umTavresi momenti misi gamowvev
mizezze zemoqmedebaa. antidepresiuli preparatebis gamoyeneba mxolod
mZime endogenuri depresiis drosaa rekomendebuli. es specialistis
meTvalyureobiT xorcieldeba.
mozardebSi gansakuTrebiT xSiria Segnebuli TviT-dazianeba. saskolo
gamokiTxvebiT gamovlinda, rom didi britaneTis skolebSi mozardebis meoTxedi
fiqrobda siucidze, maT naxevars hqonda amisaTvis mofiqrebuli raRac gegma,
8%-s ukve ganexorcielebina suicidis mcdeloba, 2% moiTxovda samedicino
daxmarebas amis gamo. gogonebi xSirad Tavis mowamvlas mimarTaven, raTa
samedicino personalis yuradReba daimsaxuron.
eqimma anamnezSi Segnebulad TviT-dazianebis epizodis SemTxvevaSi
detalurad unda gamoikiTxos mozardis socialuri da ojaxuri garemos Sesaxeb.
am pacientebs umravlesobas aReniSneba komunikaciuri sirTuleebi,
gansakuTrebiT daZabuli ojaxuri atmosfero. isini TviT-dazianebis epizodis
Semdeg mainc aRniSnaven, rom aqvT sikvdilis survilis gamomxatveli mfrinavi
ideebi. Tumca umravlesoba aRniSnavs, rom kmayofilia imiT, rom cocxali
gadarCa da ar aqvs sikvdilis survili. mudmivad umaqnisobis SegrZneba da
sikvdilis survili sagangaSo niSnebia da depresiaze an sxva fsiqikur darRvevaze
miuTiTebs, rac aucileblad unda iqnas gaTvaliswinebuli.
axalgazrdebis umravlesoba, romelsac TviTdazianebis mcdeloba hqonia
mizandasaxul suicidze iSviaTad midis, Tumca ganxorcielebuli suicidis
SemTxvevaSi axalgazrdebis mesameds anamnezSi aReniSneba arafataluri
TviT-dazianebis epizodi. ase rom, suicidis riski gansakuTrebiT maRalia mozard
pacientebSi, romelTac anamnezSi TviT-dazianebis epizodi aReniSnebaT. suicidi
aT wlamde iSviaTia, axali SemTxvevebis sixSire mozardobis periodSi
mniSvnelovnad imatebs da es tendencia mozrdilobis xanamde grZeldeba. 5-14
wlis asakSi suicidi saerTo sikvdilobis 0,5%-s Seadgens. 15-19 wlis asakSi
suicidis maCvenebeli 7,6-ia 100000-ze da saerTo sikvdilobis 14%-s Seadgens.
iseve rogorc mozrdilebSi, mozardebSic suicidi ufro xSiria biWebSi, vidre
gogonebSi. problemis simZimisa da seriozulobis gamo depresiis, anamnezSi
TviT-dazianebis epizodis an fsiqikuri daavadebis raime niSnis manifestirebis
SemTxvevaSi aucilebelia bavSTa fsiqiatris konsultaciis uzrunvelyofa.

52
 mozardebis samedicino daxmarebis Taviseburebebi

mozardis janmrTelobaze bevri sxvadasxva dargis profesionalia

pasuxismgebeli. eseni arian praqtikosi eqimebi (pediatrebi, ojaxis eqimebi,
Terapevtebi, mean-ginekologebi, qirurgebi, fsiqiatrebi), agreTve eqTnebi,
fsiqologebi, socialuri muSakebi. mozardTa sul ufro meti raodenoba erTiandeba
axalgazrdul organizaciebSi, romelic sxvasTan erTad TavianTi wevrebis
gajansaRebasac isaxavs miznad. specialuri samsaxurebi iqmneba kolejebSi,
umaRles skolebSi, samxedro uwyebebSi. faqtobrivad, samedicino daxmarebis
moculoba, xarisxi da stili gasxvavebulia Sesabamisad specialistebisa,
romlebsac mozardi mimarTavs. klinicistma, romelic movalea izrunos mozard
pacientebze unda icodes samedicino daxmarebis ama Tu im doneze arsebuli
SesaZleblobebi.
1991 wels aSS-Si ofisSi momuSave eqims 11-20 ww mozardebma 59
milionjer mimarTes: maTgan 35% iyo mimarTva ojaxis eqimTan, 18%
pediatrTan, 8% mean-ginekologTan, 7% dermatologTan, 5% TerapevtTan, 5%
ofTalmologTan, 2% fsiqitrTan, 20% sxva (upiratesad qirurgTan)
specialistebTan. mcire asakis mozardebi daxmarebisaTvis pediatrebs
mimarTaven, ufrosi Taobis ki -upiratesad mean-ginekologebs.
ukanaskneli ramodenime dekadis manZilze igrZnoba tendencia imisa,
rom mozardTa janmrTelobis dacva moeqces zogadad pediatriuli samsaxuris
farglebSi. amerikuli statistikis mixedviT, 11-14 ww-Si specialistebTan viziti
yvela vizitis 33%-s Seadgenda, 10-15 ww-Si viitebis 10% iyo pediatrTan. aseTia
situacia, miuxedavad imisa, rom aSS pediatriuli akademiis rekomendaciiT
mozardTa janmrTelobas 21 wlis asakamde pediatrebi unda
zedamxedvelobdnen.
aRniSnul Seusabamobas safuZvlad udevs Semdegi faqtorebi:
- pediatrebi ZvelTagan ~patarebis eqimebad~ arian cnobilni, amdenad
ufrosi asakis mozardis maTTan sakonsultaciod misvla sakmaod problemuria.
aseTi ram mozardis azrovnebaSi mniSvnelovani Zvrebis moxdenis gareSe
Znelad gansaxorcielebelia;
- praqtika gviCvenebs, rom bevri pediatri uars acxadebs ufrosi asakis
mozardebis miRebaze, bevri Sewuxebulia imiT, rom uWirs saubari
mozardebTan narkotikbze, seqsualur problemebze da sxva.

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 - arasruli kompetenturoba, SezRuduloba droSi, Seusabamoba mozardTan
konfidencialobis dacvasa da mSoblebis moTxovnilebebs Soris, Sesabamisi
gadasaxadebis dadgenis SeuZlebloba.
ai, arasruli CamonaTvali im sakiTxebisa, romelic pediatriul praqtikaSi
unda gadawydes, Tuki pediatrs mainc mouwevs ufrosi asakis mozardebTan
saqmis daWera. am problemebs axalgazrda pediatrebi ukeT wyveten,
romlebmac rezidentura gaiares mozardTa medicinaSi da romelTa pacientebi
asakSi maTTan erTad matuloben.
zogjer mozardebTan iseTive urTierTobaa saWiro, rogoric bavSvebTan,
xolo zogjer iseTi, rogoric mozrdilebTan. es ganisazRvreba axalgazrda
pirovnebis `simwifiTa~ da konkretuli problemiT, romelsac eqimi unda Seexos.
idealur, SemTxvevaSi, vidre eqimi problemis WeSmarit bunebas amoicnobs,
umjobesia mozardi pacienti marto iqnas konsultirebuli, xolo Semdeg
mSoblebTan an ojaxTan erTad. zogierTi mozardi sakuTar Tavs ukve
Camoyalibebul, damoukidebel pirovnebad aRiqvams. misTvis araviTar sirTules
warmoadgens eqimTan vizitis daniSvna da masTan marto misvla. aseT
SemTxvevaSi, eqimma mozardi pacientis avtonomias pativi unda sces da
frTxilad miiRos misgan Tanxmoba momdevno konsultaciaze mSoblis mowvevis
Taobaze (Tuki, raRa Tqma unda, es aucilebelia). zogierT mozards Zalian uWirs
ufrosebTan (gansakuTrebiT eqimTan) saubari da, amdenad, gaurbis maTTan
pirispir kontaqts. aseT dros, umjobesia, konsultacia mSoblis TandaswrebiT
Catardes.
zogjer eqimi grZobs, rom mozards raRacis, Zalian piradulis, Tqma surs,
magram laparakis dawyeba uWirs. saubari xangrZliv dumilSi gadadis, rac
araxelsayrelia maT Soris kargi urTierTobis dasamyareblad. Tuki eqimi rogorme
ar ecdeba am dumilis Sewyvetas, konsultaciis gamosavali arasaxarbielo iqneba
da mozardi praqtikoss im grZnobiT datovebs, rom `aq misi saTqmelis Tqma
SeuZlebelia~ da naklebad savaraudoa, rom mas momavalSi eqimTan vizitis
survili kidev gauCndes.
mozardTan konsultaciisaTvis eqims gansakuTrebuli moTmineba,
gulisxmiereba da Cvevebi sWirdeba, raTa pacients `gaxsnisa~ da gulaxdili
saubris saSualeba misces.
qronikulad daavadebuli bevri mozardi mis pediatrs Tavis erTaderT
eqimad miiCnevs. pediatrebi xSirad warmarTaven acrebis organizacias (mag.
gripis vaqcinacia asTmiT moavade bavSvebSi), sinjaven mozards sportisTvis
54
vargisianobaze. pediatri darwmunebuli unda iyos, rom misi mozardi pacienti
Rebulobs srulfasovan samedicino daxmarebas yvela aspeqtSi, rom misTvis
xelmisawvdomia saxelmZRvaneloebi sqesobriv problemebze, narkomaniaze.
amerikuli statistikiT eqimebTan mozardTa vizitebis 35% zogadi praqtikis
an ojaxis eqimTan vizitze modis.
zogadi praqtikis zogierTi eqimi amtkicebs, rom maTTvis ufro advilia
mozardebTan urTierToba imitom, rom aseTi eqimebi daostatebulni arian
saojaxo problemebis mogvarebaSi. gaugebrobebi, konfliqtebi mSoblebsa da
Svilebs Soris marTlac kargad Tavsdeba ojaxis eqimis kompetenciaSi. aseve
maT kompetencias ufro miesadageba samedicino da parasamedicino
sakiTxebi, romlebTan Sexeba upiratesad ojaxis eqimebs uxdebaT. sadReisod
zogadi praqtikis eqimebis momzadebaSi sul ufro meti yuradReba eTmoba
mozardTa janmrTelobis dacvas da amitom cxadia, rom es eqimebi
gaagrZeleben mozardebis samedicino momsaxurebas uaxloes wlebSi.
1994 wlidan aSS-Si izrdeba mozardTa eqimebis wili. am dargis zogierTi
warmomadgeneli specializdeba iseT ganxrebSi, rogorebicaa - fsiqikuri
daavadebebi, endokrinuli paTologia, narkotikebis gamoyeneba; sxvebi
warmarTaven TavianT praqtikas aseTi specializaciis gareSe.
miuxedavad imisa, rom aSS-Si didi saxsrebi ixarjeba jandacvis sistemis
srulyofaze, bevri mozardisaTvis sakmaod Znelia miiRos srulfasovani
samedicino daxmareba. mosaxleobis am populaciisTvis unda arsebobdes
mudmivi mzrunveloba, an privatul ojaxSi, an saavadmyofoebsa da
ambulatoriebSi. saerTo profilis pediatriuli saavadmyofoebSi ZlivZlivobiT
pasuxoben mozardTa moTxovnebs da siZneleebi am mxriv umal gamodis
zedapirze. imisTvis, rom mozardebs aRmoeCinoT srulfasovani samedicino
daxmareba, mravalmxrivi da STagonebuli midgomaa saWiro. am mimarTulebiT
aSS-Si bevri ram keTdeba da mravali saxelmZRvanelo gamoica. es
saxelmZRvaneloebi aiaraRebs pirveladi samedicino daxmarebis
ganmaxorcieleblebs saWiro rCevebiT skriningze, instruqtaJze, imunizaciaze
mozardTa kontigentSi. rutinuli dagegmili yovelwliuri vizitis dros prevenciuli
samedicino RonisZiebebi unda xorcieldebodes rogorc mozardis, ise misi
mSoblebis mimarT. instruqciis Sesabamisad saWiroa gamovlindes iseTi
mozardebi, romelTa saqcieli maT risk-jgufebSi moaTavsebs. samedicino
personalma unda gamoimuSaos samkurnalo gegma. sainstruqcio werilebi da
miTiTebebi dawvrilebiT unda exebodes mozardTa yvela asakobriv jgufs -
55
adreul, saSualo da ufros mozardobis wlebs. janmrTelobis Semswavleli
kiTxvarebi unda Seicavdnen `trigerul SekiTxvebs~, rogorc mSoblebisaTvis, ise
mozardebisaTvis. aqcenti unda gakeTdes zrda-ganviTarebaze, skolisa da
dasaqmebis problemebze, mozardebisaTvis samomavlo sakiTxebze.
mozardTa samedicino daxmarebisTvis gankuTvnili samedicino
dawesebulebebis, e.w. mozardTa klinikebis ZiriTadi amocanebia:
 mozard pacientebsa da eqimebs Soris ndobaze damyarebuli
urTierTkavSiris Camoyalibeba;
 pacientis waxaliseba izrunos sakuTar janmrTelobaze;
 problemis identifikacia da saWiroebis SemTxvevaSi mkurnalobis
uzrunvelyofa;
 pacientis janmrTelobis mdgomareobaze sistematuri meTvalyureoba;
 pacientis samedicino rukis gadaxedva da sistematuri ganaxleba;
 pacientis waxaliseba jandacvis samsaxurebis adekvaturi gamoyenebis
Taobaze.
mozardTa klinikebze pacientebs mozidvis mizniT, praqtikaSi arsebuli
asakisa da sqesis reestris mixedviT, arCeven samizne jgufs mag. 16 da 17 wlis
(an 12-13 wlis) pacientebi, romlebsac binaze ugzavnian mowvevis baraTs,
sadac miTiTebulia, rom momarTon praqtikas 15-20 wuTian miRebaze, raTa
miiRon maTTvis saintereso informacia janmrTelobasTan dakavSirebuli
sakiTxebis Taobaze. sxvadasxva praqtikas Canawerebis warmoebis
gansxvavebuli meTodi SeiZleba hqondes. zogierTi upiratesobas aniWebs
klinikis dros Catarebuli Sefasebis monacemebis Caweras pacientis rukaSi,
zogierTi ki amisaTvis specialurad SemuSavebuli formiT sargeblobs. Tuki 16 wlis
pacients mowveva akademiuri wlis bolos gaugzavneT da man ar mogmarTaT,
maSin igi meore mowvevas ukve 17 wlis asakobrivi jgufis pacientebs Soris
miiRebs. registratorma feradi furclebiT unda aRniSnos im pacientebis
samedicino rukebi, vinc `klinikebs` ar momarTavs. rodesac aseT pacienti
eqimTan, raime mizezis gamo Cveulebriv konsultaciaze modis, eqims iolad
SeuZlia amoicnos, rom mozards klinikisaTvis ar miumarTvas da amdenad,
konsultaciamac gansakuTrebuli saxe unda miiRos. zogadi praqtikis eqimi unda
ecados, nawilobriv mainc, gadaWras mozardTa `klinikis~ amocanebi da
amasTan, daarwmunos pacienti, rom momavalSi ar Tqvas uari mozardTa
`klinikaSi~ mosvlaze.

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 mozardTa klinikis protokoliT ganisazRvreba RonisZiebebi, rac klinikis
mimdinareobisas skrinigis, pacientis ganaTlebis an mkurnalobis mizniT
SeiZleba Catardes.
skriningi: zogierTi Sefaseba axalregistrirebuli pacientisaTvis rekomendebuli
Sefasebis analogiuria, mag. wona, simaRle, arteriuli wneva; ojaxuri anamnezi,
samedicino anamnezi, imunizaciis statusi, pacientis mier wamoWrili nebismieri
problema. garda im problemebisa, rasac pacienti Tavad wamoWris, mas unda
vesaubroT agreTve: Tambaqos mowevis, alkoholis moxmarebis, narkomaniisa
da toqsikomaniis, kontracefciis, sqesobrivi cxovrebis, qceviTi/emociuri
problemebis, SromiTi/saganmanaTleblo progresis, momavali gegmebis (mag.
kariera, ganaTleba), ojaxuri dinamikis, qronikuli samedicino mdgomareobebis
Sesaxeb.
klinikis auditi SeiZleba yoveli kohortis Sefasebis dasrulebis Semdeg
Catardes. amis safuZvelze xdeba naklis gamovlena da gaumjobesebisaTvis
aucilebeli RonisZiebebis dagegmva da ganxorcieleba, rac klinikis axleburad
organizebas gulisxmobs. Sefaseba SeiZleba Semdeg monacemebs
emyarebodes:
 pacientebis raodenoba romelic momarTavas/ar momarTavs klinikas;
 rogor xdebodaN problemis identificireba;
 ra mkurnaloba Catarda N problemis SemTxvevaSi da Tu moxda N
problemis gadawyveta;
 rogor afasebs klinikas Tavad mozardi pacienti
 rogor afaseben klinikas gundis wevrebi
es klinikis mimdinareobisas samedicino problemebis warmatebuli marTvis
Sefasebis martivi gzaa. idealur SemTxvevaSi, saWiroa Sefasdes ramdenad
moxerxda klinikis safuZvelze qcevis Secvla, Tanac ara marto pacientebisa,
aramed im eqimisac, romelic am klinikas warmarTavs.
yvelaze sasurveli cvlileba, rac mozardTa klnikis safuZvelze SeiZleba
ganxorcieldes eqim-pacients Soris ufro efeqturi urTierTobis Camoyalibeba da
mozardi pacientebis mier pirveladi samedicino momsaxurebis Sesaferisi
gamoyenebaa.
mozardTan medikosis pirveli kontaqti Cveulebrivad tons aZlevs
SemdgomisaTvis maT urTierTobas. imisda mixedviT, rogor urTierTobs eqimi
mozardTan da mis mSobelTan, naTeli xdeba misi moqmedebis stili, misi zrunvis
xarisxi mozardis janmrTelobasa da keTildReobaze. mozardis pirveli
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STabeWdileba eqimze iqmneba mosacdel oTaxSi. misTvis, gansakuTrebiT ufros
asakSi, erTnairad Znelia mosacdelSi yofna, rogorc patara bavSvebTan, ise
ufrosi asakis xalxTan. mozardi Tvlis, rom mas unda moeqcnen, rogorc mozrdil
pirovnebas da amdenad, mosacdeli oTaxi unda gamoxatavdes aseTi
ganviTarebis suraTs. iq unda iyos normaluri savarZlebi, Jurnalebi sportis,
modis, garTobis Sesaxeb, narkvevebi jandacvis sakiTxebze, literatura
mozardebisaTvis specifikur sakiTxebze. im samedicino dawesebulebebSi,
sadac mozardebi xSirad arian, unda arsebobdes sakonsultacio oTaxi wignebiT,
broSurebiT, patara saxelmZRvaneloebiT zrdis, ganviTarebis, seqsologiis,
kontracepciis da wamlebis Sesaxeb. aseTi literaturis xelmisawvdomoba
uCvenebs rogorc mozards, ise mis mSoblebs, rom es aris informacia Ria
gansjisaTvis. igi Seicavs legitimaciasac am sakiTxebisaTvis. im eqimebisaTvis,
romlebic mozardebsac Rebuloben, ukeTesia qondeT maTTvis calke misaRebi
are an gansakuTrebuli dro. Tumca, es SeiZleba praqtikuli ar iyos yvela
situaciaSi, magram ofisma unda uzrunvelyos privatuloba mozardi
pacientisaTvis.
raRac momentSi mozardebTan iseTive urTierTobaa saWiro, rogoric
bavSvebTan, xolo zogjer iseTi, rogoric mozrdilebTan. es ganisazRvreba
axalgazrda pirovnebis `simwifiTa~ da konkretuli problemiT, romelsac eqimi
unda Seexos. idealur, SemTxvevaSi, vidre eqimi problemis WeSmarit bunebas
amoicnobs, umjobesia mozardi pacienti marto iqnas konsultirebuli, xolo
Semdeg mSoblebTan an ojaxTan erTad. zogierTi mozardi sakuTar Tavs ukve
Camoyalibebul, damoukidebel pirovnebad aRiqvams. misTvis araviTar sirTules
ar warmoadgens eqimTan vizitis daniSvna da praqtikaSi marto misvla. aseT
SemTxvevaSi, eqimma mozardi pacientis avtonomias pativi unda sces da
frTxilad miiRos misgan Tanxmoba momdevno konsultaciaze mSoblis mowvevis
Taobaze (Tuki, raRa Tqma unda, es aucilebelia). zogierT mozards Zalian uWirs
ufrosebTan (gansakuTrebiT eqimTan) saubari da, amdenad, gaurbis maTTan
pirispir kontaqts. aseT dros, umjobesia, konsultacia mSoblis TandaswrebiT
Catardes.
zogjer eqimi grZobs, rom mozards raRacis, Zalian piradulis, Tqma surs,
magram laparakis dawyeba uWirs. saubari xangrZliv dumilSi gadadis, rac
araxelsayrelia maT Soris kargi urTierTobis dasamyareblad. Tuki eqimi rogorme
ar ecdeba am dumilis Sewyvetas, konsultaciis gamosavali arasaxarbielo iqneba
da mozardi praqtikoss im grZnobiT datovebs, rom `aq misi saTqmelis Tqma
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SeuZlebelia~ da naklebad savaraudoa, rom mas momavalSi eqimTan vizitis
survili kidev gauCndes.
mozardTan konsultaciisaTvis eqims gansakuTrebuli moTmineba,
gulisxmiereba da Cvevebi sWirdeba, raTa pacients `gaxsnisa~ da gulaxdili
saubris saSualeba misces.
eqimTan pirveli Sexvedra mozards SeiZleba saavadmyofoSi mouxdes. am
daZabul viTarebaSi SeiZleba Zneli aRmoCndes sasaubrod wynari oTaxis
aRmoCena. Einterviu unda warimarTos dinjad. eqimi unda iCendes did interess
mozardi pacientis mimarT SexvedrisTanave da mTeli saubris ganmavlobaSi.
aseTi saubrebi mozardsa da mis mSobels uCvenebs, rom maTTan saubari
saWiroa da saintereso. sasurvelia interviu ar wydebodes zarebiT da sxva
personalisa Tu pacientis SemoWriT.
Zalian mniSvnelovania, rogor grZnobs mozardi Tavs pirvelad eqimTan
saubrisas, magram ufro mniSvnelovania, rom eqimis sityvebma mozardSi
dadebiTi emociebi gamoiwvios. eqimma xazi unda gausvas im faqts, rom,
konkretul SemTxvevaSi, misi pacienti mozardia da ara am mozardis mSoblebi.
mozardi moxaruli unda iyos Sexvdes Tavis Tanatolebs mosacdel oTaxebSi.
Tu movlenebi ase ar warimarTa, mozardi igrZnobs diskomforts da eqim-
pacientis urTierToba fuWdeba. mozardi iolad xvdeba ainterebs igi eqims Tu
ara.
mozardze pasuxismgebeli eqimi Tavis Tavs pacientTan urTierTobaSi
Tavisuflad unda grZnobdes. mas Sinaganad unda axarebdes misi saqmianoba.
winaaRmdeg SemTxvevaSi mozardi grZnobs daZabulobas da eqimTan misi
urTierToba gaZneldeba. amasTan erTad, ar aris saWiro eqimma Tavisi saubari
da qceva mozardisas mousadagos, daemsgavsos mas Cacma-daxurviT, saubris
stiliT. mozards sulac ar surs movlenaTa aseTi mimdinareoba. eqimi, romelic
ase moiqceva, dakargavs pativiscemas mis TvalSi da misi mSoblebis TvalSi.
samuSao urTierTobebis CamoyalibebisaTvis mniSvnelovania eqimi iyos
STagonebuli, dainteresebuli da ara gamsamarTlebeli, gansakuTrebiT maSin,
rodesac aseT rols gamudmebiT mSoblebi asruleben. umravlesoba mozardebisa
izrdeba da viTardeba samedicino personalis ~xelSi~, magram zogierTi
mozardis viziti eqimTan mainc sruliad moulodnelad xdeba. amis mizezi
SeiZleba iyos sacxovrebeli adgilis cvlileba, sxva eqimis mier daniSnuli
konsultacia an ojaxis survili eqimi Seicvalos. aseTi pirveli vizitis dros sasurvelia
eqimi Sexvdes mozards da mis mSobels. Tu viTareba ar iZleva imis saSualebas
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da erT-erTi mSobeli ver movida, eqimma unda daarwmunos mosulebi, rom
meore mSoblis mosvlac Zalian sasurvelia. eqimma unda aRniSnos da
daimaxsovros is garemoeba, romelic dasaxelda meore mSoblis mousvlelobis
mizezad. es gansakuTrebiT saWiroa, Tu vizitis dros dgindeba da ganixileba
mniSvnelovani fsiqologiuri Tu samedicino problema. eqimma ar unda miiRos
zereled erT-erTi mSoblis ar mosvlis mizezad dasaxelebuli garemoeba. aseTi
mizezi xSirad ar arsebobs, mas SeiZleba ar gaagebines. mogvianebiT, rodesac
armosuli mSobeli gaigebs xolme, rom misi meore naxevari da mozardi eqimTan
iyvnen, igi xSirad sinanuls gamoTqvams imis gamo, rom TviTonac ar iyos
maTTan erTad. Tu armosul mSobels axasiaTeben, rogorc sruliad
aradainteresebuls mozardis aRzrdiT, darwmunebuli unda iyoT, rom igi
SeswavlisTvis Zalian saintereso obieqtia. mosacdel oTaxSi SepatiJebis Semdeg
eqimma unda gadawyvitos, gaesaubros yvelas erTad, Tu cal-calke. es
damokidebulia vizitis mizezebze, eqimis muSaobis stilze, drois faqtorze. eqims
SeuZlia xanmokle droiT miiRos mSoblebi da auxsnas maT, rom ZiriTad dros
dauTmobs mozards. mSoblebs SeuZliaT eqimi TavianT ojaxur problemebSi
Caaxedon da mozardis dauswreblad miawodon mas anamnezuri cnobebi da
problemaze TavianTi Sexedulebebi. aseTi qceva gamarTlebulia, Tu mozards ar
surs miiRos samedicino daxmareba da yuradReba an rodesac mSoblebs
gaaCniaT mniSvnelovani ojaxuri problemebi. eqimis zemoaRweril taqtikas aqvs
is nakli, rom mozardi iZulebulia ijdes mosacdel oTaxSi, rodesac sakiTxi exeba
swored mis problemebs. am dros mas SeiZleba moeCvenos, rom eqimi misi
mSoblebis mxares dgeba.
alternatiuli midgoma jer mSoblebTan Sexvedraa, maTTan gasaubreba da
mxolod amis Semdeg Sexvedra mozardTan. am dros eqims Tavisuflad SeuZlia
bevri dro dauTmos mSoblebs da SeuzRudavad esaubros maT. bevri ojaxi
amjobinebs aseT midgomas da mzad aris damatebiTi saxsrebic gaiRos
xangrZlivi vizitisaTvis, oRond kargad gaarkvios eqimi TavianT problemebSi.
mesame meTodia eqimis erTdrouli Sexvedra mSoblebTan da maT
SvilTan. am dros isini TavianT poziciebs gamoxataven erTmaneTis daswrebiT
da eqims SeuZlia daakvirdes maT reaqciebs, urTierTobebs. eqimma unda
gaaTamamos pacienti, bevri ilaparakos Tavis problemebze, TviTon mohyves
Tavisi avadmyofobis Sesaxeb. mSoblebs SeuZliaT daamaton informacia
saojaxo istoriidan da xSirad es cnobebi siaxlea mozardisaTvis. es mesame
meTodi yvelaze ufro sasargebloa. am dros eqimisaTvis SedarebiT advilia
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auxsnas vizitorebs kanonierebisa da konfidencialobis ZiriTadi principebi
mTlianad ojaxTan mimarTebaSi.
yovelive zemoaRniSnuli exeboda mozards, romelic eqims pirvelad
xvdeba. realurad zogierTi mozardi bavSvobis asakidan erTi da imave eqimis
yuradRebis qveSaa. SeiZleba dadges momenti, rodesac axladSeqmnili
viTarebis gamo eqimi calke unda gaesaubros pacients. am dros zogjer
mSoblebisaTvis saWiroa imis Tqma, rom mozardis gasinjvisas maTi
Tandaswreba aRar aris saWiro.
miuxedavad imisa, cal-calke Tu erTad esaubreba eqimi mozardsa da mis
mSoblebs, man meore mxares unda gaacnos konfidencialobis wesebi da
garantiebi. mozards unda eTqvas, rom informcaia ar ecnobeba vinmes misi
nebarTvis gareSe. aseTi dapireba exmareba eqims Tavidan aicilos situacia,
rodesac mSoblebi sTxoven eqims gaandos maT informacia, miRebuli maTi
Svilisagan. gamonaklisia iseTi informacia, romelmac SeiZleba mozardisa da
sxva pirovnebis janmrTeloba an sicocxle riskis qveS daayenos (mkvlelobisa an
TviTmkvlelobis cda, mniSvnelovani samedicino problema, romelic ar aris
mogvarebuli). eqimma unda gadawyvitos, emuqreba Tu ara mozards safrTxe.
aseT situiaciaSi eqimma unda gaafrTxilos ojaxi. eqimi kargad unda icnobdes
kanonebs mozardTaTvis - Tanxmobisa da konfidencialobis wesebs. es wesebi
Seicaven nebarTvas eqimisaTvis umkurnalos specifikur samedicino problemebs
mSoblebisagan Tanxmobis miuReblad. aSS es wesebi gulisxmobs iseTi
problemebis marTvas, rogoricaa orsuloba, aborti, kontraceptivebi, sqesobrivi
gziT gadamdebi daavadebebi, narkotikebTan dakavSirebuli problemebi. yvela
am sakiTxis gadaWrisas eqimi ar unda dgebodes mosamarTlis rolSi
(samwuxarod, Cvens qveyanaSi aseTi kanonebi jer ar miRebula).
mozardis interesebis damcvelma eqimma unda gaacnos mozards Tavisi
mosazrebebi da SesTavazos mas TanamSromloba problemis saukeTeso
gadaWris TvalsazrisiT.
mozardTan urTierTobaSi myof eqims esaWiroeba gansakuTrebuli taqtikis
gamomuSaveba honoraris miRebisas. zogierTi specialisti (laparakia kerZo
praqtikaze) Tanxis gadaxdas akisrebs mSoblebs, Tundac mozards dawyebuli
hqondes eqimTan siaruli mSoblebTan SeTanxmebis gareSe. sxva eqimebi
gadasaxads uweseben TviT pacient - mozards, oRond Semcirebuli odenobiT
(`konfidencialobisaTvis~).

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 mozardisaTvis konfidencialobisa da mkurnalobis safasuris sakiTxebis
dadgenis Semdeg (esec dasavluri midgomis erT-erTi gamovlinebaa,
TandaTanobiT albaT CvenTanac rom dainergeba) iwyeba saubari arsebiT
problemebze, am saubarSi unda Sediodes Semdegi sakiTxebi:
1. ZiriTadi Civilis gansazRvra
2. ojaxis istoriis Seswavla
3. TanatolebTan urTierTobis xasiaTi
4. skolaSi moswreba
5. mozardis fsiqosocialuri miRwevebi
6. mSoblebis Sexedulebebis gavlena mozardze da TviT mozardis mier
Tavis Tavis Sefaseba.
7. mentaluri statusi.
ZiriTadi Civili is mizezia, ramac moiyvana mozardi eqimTan. safuZvlianad
unda iqnas Seswavlili yvela sakiTxi, romelic dakavSirebulia am ZiriTad CivilTan.
agreTve Seswavlili unda iqnas, rogor Seexo es ZiriTadi Civili mozardis ojaxis
wevrebs, megobrebs. praqtikaSi sulac ar aris iSviaTi, rodesac mozardi pacienti
daxmarebas iTxovs sxva sakiTxis gamo da ara ise, rogorc es miaCniaT
mSoblebs. aseT viTarebaSi eqimma unda Seufardos erTmaneTs orive mxaris
informacia, rom miRebuli iqnas optimaluri gadawyvetileba.
mozardisTvis damaxasiaTebelia imis Tqma, rom is mosulia ubralod
SemowmebisaTvis. aseT SemTxvevebSi Zalian saWiroa imis zustad dadgena,
ratom aris is mosuli SemowmebisaTvis swored axla da ratom ar dakmayofilda
im gegmiuri SemowmebiT, romelzedac mas regularulad ibarebdnen.
ojaxis anamnezis Sekreba gulisxmobs imis dadgenas, Tu vin arian ojaxis
wevrebi da visTan rogori urTierToba aqvs mozards. rogoria ojaxis istoria
samedicino TvalsazrisiT. amave dros, mozards ar unda movTxovoT ojaxuri
saidumloebebis gacema (uTanxmoeba mSobelTa Soris, mSobelTa alkoholizmi
da sxv.). aman SeiZleba pacientisa da mSoblebis ganawyeneba gamoiwvios.
aucileblad Sesaswavlia mozardis urTierToba TanatolebTan. hyavs mas
saukeTeso megobari? Tu ki, ramden xans grZeldeba megobroba? ras akeTeben
amxanagebi erTad? rogor inawileben megobrul funqciebs? intervius dros
aucileblad dainteresdiT seqsualuri sakiTxebiT, magram nu gamoTqvamT eWvs
homoseqsualobis SesaZleblobebze.

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 SekiTxvebi sigaretis, narkotikebis da alkoholis irgvliv gulaxdil pasuxebs
moiTxovs, iseve rogorc SekiTxvebi seqsualobaze. SeekiTxeT mSoblebis gareSe,
maTi erToblivi interviu gadadeT cota mogvianebiT droisaTvis.
yuradRebiT aris Sesamowmebeli skolaSi moswreba - warmatebebi da
warumateblobebi. zogjer, eqimma dawvrilebiT unda Seiswavlos moswavlis
niSnebi. man agreTve unda icodes samomavlo gegmebi, rogorc mozardis,
aseve mSoblisa. Tu eqims es gegmebi ararealurad miaCnia, esec unda iTqvas,
cxadia, didi taqtiT.
mozardebs, rogorc wesi, saxlidan wasvla da damoukideblad cxovreba
surT. maTi amgvari gegmebi advilad SeiZleba iqnas gagebuli mTeli rigi
SekiTxvebiT.
rodesac eqimi esaubreba mozards raime mwvave problemis Sesaxeb
(fsiqosocialuri problema, momavlis gegmebi), mniSvnelovania imis dadgena,
rogorc uyureben am problemas mozardis mSoblebi da rogor uyurebs mas TviT
mozardi. am sakiTxSi eqims daexmareba 10 sakvanZo SekiTxva orive mxaris
mimarT.

SekiTxvebi mozards
 ras fiqroben Senze Seni klaselebi?
 rogor gaxasiaTeben Sen Seni mSoblebi?
 Seni azriT, sad iqnebi Sen 5 wlis Semdeg?
 ras Secvlidi Sen Sens cxovrebaSi?
 Sen rom yofiliyavi Cems adgilze, ras urCevdi Sens pacientebs?

SekiTxvebi mSoblebs
 ra aris Tqveni mozardis Zlieri mxareebi?
 ra aris, Tqveni azriT yvelaze cudi, rac SeiZleba mouvides Tqvens Svils?
 ra viTarebaSi xedavT Tqvens Svils 5 wlis Semdeg?
 aris Tu ara Tqveni mozardi amJamad bednieri?
 ra SemTxvevaSi iTvaliswinebs an ar iTvaliswinebs Tqveni Svili Tqvens
rCevebs?

am kiTxvebze pasuxi bevr informacias iZleva, Cndeba axali kiTxvebi,

axali problemebi. Tu mSoblebs ar SeuZliaT daasaxelon TavianTi mozardis Zlieri

63
mxareebi, es miuTiTebs mSoblebis uyuradRebobaze Svilis mimarT da am
ukanasknelis TavisTavis pativiscemis dabal xarisxze.
mozardis mentaluri statusis gamokvleva iTvaliswinebs sityvier da
arasityvier komponentebs. yvelaferi unda iqnas gaTvaliswinebuli, mozardis
qceva, Cacma, sityva-pasuxi. eqimi unda daakvirdes saxis gamometyvelebas,
mzeras, mixvra-moxras. mniSvnelovania SekiTxvebze emociuri reaqciebi. unda
Sefasdes mozardis sasaubro ena, misi kvebiTi Cvevebi, wona, misi mosazrebebi
Tavisi wonis Sesaxeb. pirdapir aris saWiro SekiTxva SesaZlo depresiis, suiciduri
azrebis Sesaxeb. Sesafasebelia TviTkritikis unari, msjelobis siRrme. imis
mixedviT, Tu rogor pasuxobs mozardi SekiTxvas, sakmaod kargad SeiZleba
misi inteleqtis donis Sefaseba. yvela dasaxelebuli sakiTxis garkveva erTi
Sexvedrisas yovelTvis ver xerxdeba. umjobesia es moxdes ramodenime
SexvedraSi daaxloebiT 2 kviris manZilze, ise, rom TiToeuli saubari
grZeldebodes 20-30 wT. amgvar saubrebs mozardi ufro advilad egueba da
naklebad ufrTxis. aseTi gasaubrebis – Seswavlis Semdeg ufro advilia
mkurnaloba - daxmareba Civilis sapasuxod pirvelive interviudan iwyeba.
ramdeni xnis manZilzec ar unda grovdebodes cnobebi, mozardi Tavs
Tavisuflad unda grZnobdes. dasawyisSi umjobesia SedarebiT neitraluri
SekiTxvebi - sad cxovrobs, romel skolaSi dadis. eqimma unda gamoavlinos
daintereseba da ikiTxos ganmeorebiT, Tu pasuxi bolomde gasagebi ar aris.
dasaSvebia amgvari: `me ar var darwmunebuli, rom kargad gavige Tqveni
pasuxi, SegiZliaT erTxel kargad amixsnaT?~ TviT eqimis SekiTxvebi
mozardisaTvis gasagebi eniT unda iyos dasmuli, rom kontaqti massa da
mozards Soris advilad damyardes. mozardma ar unda igrZnos, rom mas
elaparakebian `zemodan~, an rogorc pataras. umjobesia SekiTxvebi, romlebic
ar moiTxoven aucileblad `diax~ an `ara~ pasuxebs; mag., umjobesia - ra
moswons an ra ar moswons skolaSi? vidre - mogwons skola? eqimma ar unda
moiTxovos swrafi pasuxi, xanmokle pauzebi sasargebloa, am dros mozardi ar
ganicdis zedmet fsiqologiur zewolas.
arsebobs kidev erTgvari teqnika, romelic aadvilebs kontaqts da
informaciis miRebas. magaliTad, me vici, rom bevri mozardi Tqvens asakSi
svams alkoholur sasmels samxiarulo Sexvedrebis dros, Tqven rogor uyurebT
amas? aseT viTarebaSi mozardi ver grZnobs, rom mas adanaSauleben. eqimi
yuradRebiani da mgrZnobiare unda iyos mozardis reaqciebis mimarT. Tu
mozards cremlebi moadga Tvalze raime SekiTxvasTan dakavSirebiT, sasurvelia
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uTxraT -– rogorc Cans, am Temaze saubari TqvenTvis sawyenia, ratom?
gabrazebul an mtrulad ganwobil mozards, romelic yvelafers uaryofs,
miuxedavad misi mSoblebis wuxilisa, SeiZleba eTqvas - me vxedav, rom dRes
Zalian gabrazebuli xarT. rodesac adamiani gabrazebulia, misTvis saubari
Znelia, gaqvT axla aseTi grZnoba? komunikacia mozrdilsa da eqims Soris
SeiZleba daiwyos, Tundac saubrisaTvis ar iyos kargi situacia.
mozardis qcevis axsnisas garkveuli xelisSemSleli momenti arsebobs.
upirvelesad yovlisa, eqimisaTvis macduria Seafasos mozardis qceva im
formularebiT, rogoriTac fasdeba igi bavSvobis asakSi. Tu mozardi daWeril iqna
maRaziis gaqurdvisas, eqimma SeiZleba uTxras mSoblebs, rom es ar aris
mZime danaSauli - erTxel igic daakaves amgvari danaSaulisaTvis (es,
rasakvvirvelia, gulisxmobs, rom eqimi am saqmidan `mSvidad~ gamovida, rom
maRaziis gaqurdvaSi monawileobam xeli ar SeuSala mis karieras). meore rigSi,
xSirad eqimi qvecnobierad aigivebs mozardi pacientis qcevas Tavisi
SvilebisasTan. eqimi, romelic daupirispirda marixuanis mowevis problemas
pacient - mozardebSi, varaudobs, rom misi pacientis mSoblebi iziareben mis
Sexedulebebs da, Sesabamisad, esaubreba maT. bolos ki, eqimi zogjer
mozardis saqciels mcdari poziciidan gansazRvravs. pediatriul literaturaSi
arsebobs informacia mozardebis normaluri da aranormaluri qcevis Sesaxeb.
aseTi informacia ufro kargi saxelmZRvaneloa praqtikisaTvis, vidre eqimis zogjer
araswori Sexedulebebi saqmis arsis Sesaxeb.
gamokiTxva unda damTavrdes SejamebiT. mieciT mozards saSualeba
pasuxis gacemisa da SekiTxvebisa. dasaSvebia, rom gamokiTxvisas zogierTi
sakiTxi gamotovebul iqna. amitom SeekiTxeT - xom ar gamovtove iseTi ram,
rac me unda vicode? amiT dasturdeba, rom eqimi SezRudulia daxmarebis
SesaZleblobebSi, Tu man ar miiRo sruli informacia sakiTxze da gulisxmobs, rom
pacienti da mSoblebi inawileben pasuxismgeblobas informaciis miucemlobis
Sedegebze. rodesac gamokiTxva jamdeba calcalke mSoblebTan da
pacientebTan, umjobesia Sejameba moxdes jer mozardebTan, Semdeg ki
gameordes mSoblebis daswrebiT.
eqimisa da mozardis urTierToba mraval damatebiT niunss moicavs; ase
magaliTad, mozardebi ar arian miCveuli marto mimarTon eqims. problema,
romlis gaziarebac maT ojaxTan ar surT, xSirad xdeba eqimTan pirveli,
damoukidebeli (anu konfidencialuri) konsultaciis mizezi. gasakviri ar aris, rom
mozardi, aseT dros, uxerxulobas grZnobdes da sakuTari problemis gamoTqma
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uWirdes. samedicino personals didi gulisxmierebis gamoCena marTebs, rac
daexmareba maT momavalSic daimsaxuros mozardis ndoba. ase masTan
urTierToba gacilebiT ioli gaxdeba. qronikulad daavadebis mqone
mozardebisaTvis samedicino sferosTan kontaqti imdenad Cveulia, rom
uxerxulobasTan naklebad aris dakavSirebuli. Tumca, es pacientebi gaurbian
sqesobriv sferoze, sqesobriv momwifebasTan dakavSirebiT organizmSi
mimdinare cvlilebebze saubars. eqimi unda cdilobdes es Temebi `Ria~ da
`Cveulebrivi sasaubro~ gaxados.
uamravi masala arsebobs imis dasadastureblad, rom mozardebi mSoblebis
TandaswrebiT TavianTi WeSmariti problemebis Sesaxeb arafers amboben. ise
rom samedicino personalma zogjer unda moaxerxos mozard pacientTan
konsultaciis dros marto darCena, ise, rom mSobels amis gamo raime eWvi ar
gauCndes. axalgazrdebis warmodgenaSi eqims mxolod fizikuri problemebis
mogvareba SeuZlia. amis gamo isini yelis tkivils, Tavis tkivils da surdos
eqimTan `saSvis~ saxiT iyeneben. mozardi, romelic eqims am problemebis
gamo mimarTvas, SesaZloa ufro seriozul problemas malavdes, Tuki eqimi misi
`WeSmariti~ problemis identificirebas ver moaxerxebs (mag. depresiis)
gamova, rom mozardma `eqims tyuil-ubralod mimarTa~. saWiroa amis Tavidan
acileba. samedicino profesionalebisaTvis Znelia metyveleba samedicino
Jargonebis gamoyenebis gareSe. maTma umravlesobam ar icis `mozardebis
ena~. kargi iqneba, Tuki, gundis wevrebi SearCeven garkveul sityvebs,
romlebic Sekrulobis, sqesobrivi kavSiris, sasqeso asos, saSos, narkotikebisa da
masturbaciis analogi iqneba.
konfidencialoba, Tanxmoba - legaluri da eTikuri sakiTxebi.
janmrTelobis dacvis specialistebi, romlebic urTierToben mozardebTan, xSirad
arian iZulebulni gadawyviton bevri iuridiuli da eTikuri problema. amisaTvis
unda arsebobdes iuridiuli baza. sxva sakiTxebi moiTxoven konsultacias
iuristebTan. eTikuri problemebi iseTive komleqsia, rogorc legaluri sakiTxebi da
moiTxoven multidisciplinarul ganxilvas. didi mniSvnelobis legaluri da eTikur
sakiTxebi mozardTa medicinis mimarTebaSi moiTxovs konfidencialobisa da
Tanxmobis gadaWras, agreTve mkurnalobis anazRaurebis sakiTxis
gadawyvetas. bazisuri kiTxvebi yoveli kategoriisaTvis aseTia:
1. vin unda gamoTqvas Tanxmoba mkurnalobaze, visi Tanxmobaa saWiro?
2. ra farglebSia dasaSvebi konfidencialoba mkurnalobis procesSi?

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3. vin aris pasuxismgebeli mkurnalobis fuladi anazRaurebisaTvis - mozardi,
misi mSoblebi, sazogadoebrivi Tu piradi damzRvevi, Tu vinme sxva?
es sakiTxebi unda wydebodes kanonze damyarebul principebTan
SesabamisobaSi. eqimebma, romlebsac urTierToba aqvT mozardebTan, unda
icodnen kanonebi. eqimebma unda icodnen agreTve samedicino eTikis ZiriTadi
principebi, vinaidan isinia maTi muSaobis safuZveli. mozardebis legaluri statusi
da ganviTarebis maxasiaTeblebi gansxvavdeba bavSvebisa da mozrdilebis
aseTive parametrebisagan. mozardebs kanoni ar aZlevs uflebas
damoukideblad gadawyviton bevri problemuri sakiTxi - kanonis Sesabamisad,
isini amisaTvis ganviTarebis TvalsazrisiT ar arian uflebamosilni.
istoriulad, mozardTa mimarT problemuri sakiTxebis gadawyveta
mSoblebs aqvT mindobili. XX saukunis dasawyisidan saxelmwifom daiwyo
Careva mSoblebis am `tradiciul~ uflebebSi - miCneul iqna, rom mSoblebi
araiSviaTad zedmetad iyeneben TavianT uflebebs, zogjer ki borotebasac
Cadian. meores mxriv, kanoni rig SemTxvevebSi swored mSoblebs
avaldebulebs gadawyviton mozardTa janmrTelobis problemebi.
mozardTa uflebis dacvas aSS-Si didi yuradReba eqceva. konstituciurad
aris ganmtkicebuli maTi uflebebi Tavisuflad ilaparakon saskolo Sexvedrebze,
sasamarTlo procedurebze. maT aqvT zogierTi gadawyvetilebisa da qmedebis
gasaidumloebis ufleba kontracefciisa da abortis gakeTebis sakiTxebSi. aseTi
umaRlesi sasamarTlo gadawyvetilebis paralelurad aSS-is rig StatebSi kanoni
afarToebs da iuridiulad ganamtkicebs urTierTobis farglebs mSoblebsa da
mozardebs Soris. es gansakuTrebiT swored aRniSnul problemebs exeba. igive
iTqmis narkotikebis gamoyenebis sakiTxze (cxadia, yovelive es jer-jerobiT Soria
Cveni qveynis praqtikisagan, magram aq mTavaria tendenciebis
gaTvaliswineba).
mkurnalobaze Tanxmobis miReba eqimis muSaobis aucilebeli
Semadgeneli nawilia. am moTxovnis Seusrulebloba SeiZleba safuZveli gaxdes
eqimis pasuxismgeblobis gamoZiebisa iuridiuli organoebis mier. mkurnalobaze
Tanxmobis miRebas aqvs agreTve eTikuri mxare - igi uzrunvelyofs
pativiscemas pacientis, rogorc pirovnebis mimarT.
aSS-Si mozardTa eqimis mier mSoblebis Tanxmobis miReba tradiciulad
efuZneboda kanonSi 2 prezumpcias: pirveli - iTvleboda, rom mozardi iuridiulad
ar aris uflebamosili misces eqims Tanxmoba. meore - mozardi ar aris amisaTvis
sakmaod ganviTarebuli. bevr situaciaSi mSoblebisagan Tanxmobis miReba
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mxolod dadebiTi faqtoria mkurnalobisaTvis. amave dros, aseT SemTxvevebSi
mozardebi, romlebsac ar surT mSoblebTan TavianT problemebze saubari, ver
Caitareben mkurnalobas. es rom ar moxdes, mTel rig iuridiul instanciebSi
damuSavebulia gzebi am winaaRmdegobis dasaZlevad.
zemoTqmulTan damatebiT aSS-Si arsebobs doqtrina momwifebul
mozardTa Sesaxeb; am doqtrinis Sesabamisad, zogierTi mozardi savsebiT
acnobierebs mosalodneli mkurnalobis risks an sargeblianobas. aseTi doqtrina
mxolod ramodenime StatSi moqmedebs, garda am doqtrinisa, aSS-Si arsebobs
cneba emansipirebuli mozardis Sesaxeb. aseTebad iTvlebian mozardebi,
romlebic msaxuroben jarSi, arian daqorwinebulni, ewevian bizness. aseTi
mozardisTvis gaadvilebulia mkurnalobaze damoukideblad Tanxmobis micema.
saerTod, bavSvTa uflebebis deklaraciis Tanaxmad, mozardi uflebamosilia
monawileoba miiRos im problemis gadawyvetaSi, romelic mas da mis
janmrTelobas exeba.
aSS-Si yovel Stats aqvs Tavis kanonebi, romlebic iTvaliswinebs
daavadebebs, daqvemdebarebuls mozardisagan mkurnalobaze Tanxmobis
misacemad. uxSiresad esenia: saswrafo daxmareba, kontraceptivebis
gamoyeneba, orsulobasTan dakavSirebuli sakiTxebi, sqesobrivad gadacemuli
daavadebebis mkurnaloba, Sidsi, alkoholis miRebasTan dakavSirebuli
problemebi, narkotikebi.
rodesac mozardi Tanxmobas iZleva mkurnalobaze, man eqimisagan unda
miiRos Semdegi informacia: diagnozi im daavadebisa, romelsac mkurnalobs,
dagegmili proceduris riski da sargebloba; alternatiuli mkurnaloba da
procedurebi; mkurnalobis SesaZlo Sedegebi.
konfidencialuroba eqimTan urTierTobaSi mozardisaTvis Zalian bevrs
niSnavs. bevri mozardi uars acxadebs mkurnalobaze eqimisagan
konfidencialurobis garantiis miuxedavad, konfidencialuroba mkurnalobis
procesSi aSS-Si kanoniTacaa ganmtkicebuli. kanonebi imasac iTvaliswinebs, Tu
rodis SeiZleba konfidencialobis darRveva mkurnalis mier; mag., mozardze
emociuri, seqsualuri, narkotikuli saSualebebiT zemoqmedebis SemTxvevaSi,
saSiSroebis arsebobisas mozardis Tu sxva pirebis mimarT, zogierTi saSiSi
infeqciis gavrcelebis saSiSroebisas da sxva.
mniSvnelovania mkurnalobis safasuris sakiTxebic. amaze pasuxismgebelia
zogjer mSoblebi, zogjer ki TviT mozardebi. umravlesoba mozardebisa ar aris
gadamxdelunariani da maTTvis sxvadasxva sadazRvevo organizacia ixdis.
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 mozardTa jandacvis samsaxuris srulyofa

mozardebs Soris janmrTelobis pirveladi profilaqtika gulisxmobs janmrTeli

ganviTarebis uzrunvelyofas da janmrTeli cxovrebis wesis damkvidrebas.
amisaTvis saWiroa gansakuTrebuli politika, informaciis miwodeba informaciis
saSualebebiT, ganaTleba. am mimarTulebiT didi mniSvnelobis mqonea
sakiTxebi, romlebic pirdapir ar exeba mozardebs, magram arapirdapiri gagebiT
maTze didad zemoqmedeben; kontroli Tambaqos reklamaze da alkoholur
sasmelebze. zogierT qveyanaSi (mag. safrangeTSi) avtomobilebis
mwarmoeblebs miTiTebuli aqvT avtomobilis gayidvisas ar gaakeTon didi
aqcenti maT siCqareze.
mozardebisaTvis informaciis miwodeba SeiZleba calmxrivi arxebiT -
radio, televizia, kasetebi, wignebi, Juralebi da a.S. da ormxrivi arxebiT -
telefoniT, werilobiTi SetyobinebiT. am ukanasknelis dros mozards eZleva
saSualeba upasuxos Semtyobinebels.
ganaTleba marto imas ki ar gulisxmobs, rom miawodos mozards
informacia, aramed xelisSewyobasac inteleqtualuri, socialuri da moraluri
ganviTarebisaTvis. janmrTelobis dargSi ganaTleba moicavs xelmZRvanelobas
higienis, Sromisa da dasvenebis, swavla-ganaTlebis, kvebis, seqsualuri
urTierTobebis dargSi. amis paralelurad, misi daniSnulebaa SeaZlebinos
mozardebs gansazRvron Tavisi janmrTeli momavali da izrunon mis
uzrunvelsayofad. aseTi ganaTlebisaTvis 2 umTavresi instancia arsebobs - skola
da ojaxi. am pirvel doneze mozardTa ganaTlebaSi bevri pirovnebaa CarTuli;
igive doneze mozardebi urTierToben axalgazruli organizaciis wevrebTan,
religiur sazogadoebebTan da sxva. SesaZloa mozardebze yvelaze did gavlenas
axdendnen garTobisa da sportis dargebis gmirebi, romlebic agreTve SeiZleba
daqiravebul iqnan mozardTa janmrTelobis sakiTxebSi ganaTlebisaTvis.
meoradi profilaqtika gulismobs risk-faqtorebis identifikacias, cnobilia, rom
zogierTi axalgazrda mometebulad mgrZnobiarea zogierTi daavadebisadmi da
mavne garemo faqtorebisadmi Tavisi genetikuri, fsiqologiuri Tu socialuri
garemoebebis gamo. samwuxaroa, rom bevr skolas ar gaaCnia saSualebebi
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mozardebis skriningisaTvis. ufro metic, msoflioSi bevri mozardi ar dadis
skolaSi. aseTebi iZulebulni arian daeyrdnon mxolod Tavis Tavs da TavianT
ojaxebs. Tu sazogadoebrivi informacia janmrTelobis sakiTxebze xelmisawvdomi
da sruluflebiania, savaraudoa, rom es axalgazrdebi yurs miugdebdnen mas, Tu
dasWirdaT.
janmrTelobis skriningi zogierT SemTxvevaSi, met-naklebi warmatebiT
mimdinareobs samsaxurSi an jarSi.
TviT jandacvis seqtorSi pirveladi jandacvis muSakebi da ojaxis eqimebi
am mizniT yvelaze kargi da Sesaferisi warmomadgenlebi arian. zogierT
qveyanaSi (mag. kuba) Seqmnilia risk-faqtorebis identifikaciis kargi samsaxuri.
ojaxis dagegmvis klinikebi da orsulobis legalurad Sewyvetis klinikebi (sadac
isini arseboben) kargi saSualebaa im mozardebis gamosavlenad, romlebic
seqsualurad aqtiurni arian, magram ar iyeneben sworad an saerTod
kontrfacefciul saSualebebs.
zogierT qveyanaSi arsebobs satelefono samsaxuri, romelSic
gaerTianebulni arian winaswar momzadebuli nebayoflobiTi pirebi, romlebic
uweven konsultaciebs mozardebs ojaxis dagegmarebis sakiTxebze. es
samsaxurebi uamrav satelefono zarebs pasuxoben. meoradi prevencia efeqturi
mxolod maSinaa, Tu mozardebTan kontaqts Sesabamisi samsaxurebi sakmaod
adre amyareben; es ormxrivi procesia – oficialuri seqtori mimarTavs mozards,
es ukanaskneli ki mosurne unda iyos upasuxos SemoTavazebebs, unda
sjerodes maTi. axalgazrda yovelTvis ver bedavs amas, mas eSinia sasjelis,
zogjer TviT mkurnalobis procesis, xSirad ki man ubralod ar icis, vis mimarTos.
adamianebi, romlebsac aqvT mosmenis unari, avlenen pativiscemas mozardis
mimarT, ufro miizidaven mozardebs, maT ufro meti Sansi aqvT aRmoCndnen
damxmareTa rolSi. mozardTan muSaobis ZiriTadi mizania man Seignos, rom igi
erTaderTia, romelsac SeuZlia Secvalos sakuTari yofa. axalgazrda CarTuli unda
iyos im programebis ganxorcielebaSi, romlebic maTi daxmarebisaTvis aris
mowodebuli. am mxriv didi saqmis Sesruleba SeuZliaT skolebs, magram maTSi
(gansakuTrebiT CamorCenil qveynebSi) arsebuli Sesabamisi samsaxurebi
xSirad ufro imaze zrunaven, rom gamoavlinon da dasajon mozardebi, vidre
aRzardon isini. isini ver iqnebian mozardebis damxmareni, rodesac am
ukanasknelT aqvT emociuri Tu fsiqosocialuri problemebi.
mesame etapis profilaqtikis Zireuli elementebia daavadebaTa da
dazianebaTa mkurnaloba da reabilitacia. garTulebebi gacilebiT ufro advili
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samkurnaloa, Tu mozards gacnobierebuli aqvs problema da Tu jandacvis
muSakebs kargad aqvT gaazrebuli mozardis janmrTelobis saWiroebebi. rodesac
mozards esaWiroeba, magaliTad, saavadmyofoSi didxans darCena xangrZlivi
mkurnalobisaTvis, misTvis aucilebelia saTanado garemos Seqmna (skolis
programis daZleva, urTierToba TanatolebTan, fsiqosocialuri da fizikuri
ganviTarebis uzrunvelyofa). es sakiTxebi metnaklebad warmatebiT aris
gadaWrili mowinave civilizebul qveynebSi, magram didad problematuria
ganviTarebad qveynebSi. aucilebelia gamoinaxos gzebi, romlebic daexmareba
mozardebs daZlion problemebi, momavalSi xifaTis Semqneli janmrTelobisa da
sicocxlisaTvis. mozardebSi gansakuTrebiT advilad viTardeba davrdomiloba
iseTi mizezebiT, rogorebicaa avto-satransporto SemTxvevebi, sportuli
travmebi, ubeduri SemTxvevebi saxlSi. zurgis tvinis dazianebebi, romelTa
Sedegadac yalibdeba dambla, gansakuTrebiT stresulia axalgazrdebisaTvis.
aseT SemTxvevebSi reabilitacia unda warimarTos pirovnebis mimarT ise, rom
igi ganviTardes fizikuradac, fsiqologiuradac da socialuradac. es rTuli amocanaa,
igi moiTxovs warmatebul TanamSromlobas sxvadasxva socialur instituts Soris
(jandacvis, ganaTlebis, SromiTi dasaqmebis, axalgazrduli da socialuri,
arasaxelmwifoebrivi organizaciebis). am seqtorebis saqmianoba unda
warimarTebodes ara marto axalgazrdebis mimarT, aramed im adamianebis
mimarTac, romlebTan mouwevT Sexeba mozardebs. miuxedavad imisa, rom
travmebi da maT Sedegad miRebuli dazianebebi mozardebisaTvis ukiduresad
mZimea moraluri TvalsazrisiT, isini gasaocar mdgradobas da sulis siZlieres
avlenen mTel rig SemTxvevebSi (Tu am mxriv didi mxardaWera aqvT
zemodasaxelebuli samsaxurebis TanamSromlebisagan).
mozardebis samedicino daxmarebis ganxorcieleba bevrnairad SeiZleba:
saerTo samkurnalo dawesebulebebSi, specialurad mozardebisaTvis
gaTvaliswinebuli dawesebulebebSi, komunalur, saskolo da socialur
samsaxurebis, axalgazrduli organizaciebis (romlebic Seicaven jandacvis
komponentebs) meSveobiT.
tradiciuli ganaTleba jandacvis sakiTxebSi skolebSi didaqtikuri xasiaTisaa.
igi ganixilavs ZiriTadad, higiebis sakiTxebs. zogjer Seicavs sqesobrivi
ganaTlebis elementebsac, samwuxarod, umravles SemTxvevaSi am
problemebze saubari mozardebTan ar mimdinareobs srulfasovnad; zogjer
maswavleblebi ar arian amisaTvis mzad, zogjer avtoritetebi krZalaven am
Temaze Rrmad saubars. gamocdilebis gareSe am sakiTxebze saubari sasurvel
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Sedegebs ver aRwevs. mozardebSi Zalian mniSvnelovania jansaRi cxovrebis
wesis damkvidreba da iseT sakiTxebze yuradRebis gamaxvileba, rogoricaa
Tambaqos moweva, varjiSi, dieta da usafrTxo seqsi. cxadia, es sakiTxebi unda
ganixilebodes rogorc skolaSi, aseve eqimTan miRebazedac. profesionalebis
umetesoba cdilobs am sakiTxebs konsultaciis dawyebisTanave Seexos. Tumca
arc es aris saukeTeso arCevani, vinaidan mozardi, romelic konsultaciaze misi
problemis ganxilvas moelis didi gulisyuriT, ar moismens am rCevebs, vidre
misTvis ufro mniSvnelovani sakiTxis Taobaze amomwurav informacias ar
miiRebs.
zogierT skolebSi SesaZlebelia skriningis Catareba fizikalur, smeniT da
aRqmiT naklovanebebze dasakvirveblad, zog skolebSi gamaxvilebulia
yuradReba gulsisxlZarRvTa sistemis Seswavlaze. Tu aseTi muSaoba skolebSi
maRal donezea, Sedegebic SesamCnevia. ase, mag., osloSi (norvegia) 1979-81
w.w. didi muSaoba Sesrulda moswavleTa Soris maTSi cxovrebis jansaRi wesis
damkvidrebis mizniT. muSaobis CamTavrebis Semdeg aRiniSna sportSi
CabmulTa ricxvis mateba, kvebiTi Cvevebis gajansaReba (naklebad karaqi,
naklebi maRali kaloriulobis sakvebi), gamovlinda axali cxovrebis wesiT
mcxovreb moswavleebze bioqimiuri maCveneblebis gaumjobeseba,
hemodinamiuri parametrebis gaumjobeseba da sxva.
meore mTavari instancia mozardTa janmrTelobis dasacavad aris
jandacvis sistema. Tumc zogierT SemTxvevaSi mozardebisaTvis arsebobs calke
samkurnalo dawesebulebebi, ZiriTadad isini daxmarebas iReben an bavSvTa,
an mozardTa samkurnalo obieqtebSi.
zogierT qveynebSi, upiratesad mowinaveebSi, – arsebobs garkveuli
programebi, romlebic ama Tu im sakiTxs ufro Rrmad ikvleven da Sesabamisad,
am kategoriis avadmyof mozardebs ufro xarisxianad mkurnaloben. amgvari
profiluri midgoma daavadebis mkurnalobisadmi zogjer friad efeqturia.
mozardTa jandacvis sistemis Semadgeneli nawilia organizaciebi da
asociaciebi, romelTa mTavari daniSnulebaa gaaRviZon maTSi interesi
sportisadmi, rekreaciuli da reabilitaciuri samsaxurebisadmi. aseTi organizaciebi
saWiroeben mozardis janmrTelobis Semowmebas struqturaSi miRebamde. isini
iZlevian informacias iseT sakiTxebze, rogoricaa sportuli forma, kvebiTi Cvevebi,
personaluri higiena, sporti.
msoflios zogierT qveyanaSi mozardTa jandacvis samsaxuri
gansakuTrebul daxmarebas uwevs gogonebs, romlebic iZulebulni arian
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dastovon skola fexmZimobasTan dakavSirebiT. daressalamSi (tanzania)
axalgazruli centri amgvar muSaobas eweva. am centrSi orsul gogonebs
ugrZeldebaT skolis programiT swavla, amave dros maT utareben kursebs
janmrTelobis sakiTxebze, higienaze, bavSvTa movlaze.
sakonsultacio samsaxuri metad mniSvnelovania, individualuri da jgufuri
swavlebisas didi yuradReba eTmoba sakuTari Tavis pativiscemis, Rirsebis,
damoukideblobis gamomuSavebas da damkvidrebas, centris TanamSromlebi
axalgazrda dedebs saxlSic naxuloben, imis dasadgenad Tu ratom gagaacdina
man mecadineoba, xom ar gaxda avad da a.S.
saWiroa dakvirveba da dadgena, ramdenad gaamarTlebs samomavlod
aRwerili xasiaTis muSaoba mozard dedebTan.
mozardebs esaWiroebaT daxmareba sakuTari Tavis kargad SefasebaSi.
vinaidan SeiZleba SecdomiT ver gamouvlindes sarisko mdgomareoba. bevri
mizeziT isini xSirad ar miakiTxaven xolme jandacvis dawesebulebebs, rodesac
aqvT janmrTelobis problemebi. zogjer isini ver iziareben, rom sWirdebaT
daxmareba, zogjer ar ician, rom daxmareba SeiZleba, ar ician vis miakiTxon, ra
Rirs samedicino daxmareba da sxva amdagvari. zogjer maT ar ician, rom maT
miiReben, rogorc pacientebs, zogjer ar arian darwmunebulni, rom
konfidencialuroba iqneba daculi. yovelives gaTvaliswinebiT, aucilebelia, rom
aRniSnul centerebSi momuSaveTa Soris iyos. muSakTa ZiriTadi birTvia,
romelsac kargad aqvs gaTavisebuli mozardebTan muSaobis problemebi da
sirTuleebi.
mozardTa jandacvis srulyofili samsaxuris Seqmna ar aris advili saqme.
erTiani da unaklo programebi da miTiTebebi am mimarTulebiT ar arsebobs.
janmrTelobis dacvis saerTaSoriso organizacia gvawvdis principebs mozardebis
janmrTeli ganviTarebis SesaZleblobebis gasaumjobeseblad:
 xelisSemwyobi garemo xangrZlivi periodis ganmavlobaSi,
daxarisxebuli nabijebiT avtonomiurobis, sakuTari Rirsebis da janmrTeli
cxovrebis wesis dasamkvidreblad;
 kargi urTierTobebi axalgazrdebs Soris da Rirseuli ufrosebi da
Tanatolebi maT gverdiT;
 mozardebis yofaqcevisa da rwmenis jansaRi gageba yovelive
mocemuli kulturis farglebSi;

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  im adamianebis gamoyeneba, romlebsac esmis axalgazrdebisa da
pativs scemen maT, ician maTi moTxovnebi da dauflebulni arian
mozardebTan urTierTobis xelovnebas;
 programebis fokusireba mTlianad cxovrebis stilze da ara qcevis
individualur aspeqtebze.
 programebis interseqtoraluri Seswavla, wamyvani jgufebis srulad
CarTva muSaobaSi – skolebis, ojaxebis, jandacvis sistemis
dawesebulebebis, religiuri da sazogadoebrivi jgufebis gamoyeneba;
 mtkice kavSirebi sazogadoebriv da saskolo programebs Soris;
 rac SeiZleba meti axalgazrdobis CarTva programebis dagegmvasa da
SesrulebaSi.

mozardebis aqtiuri roli pirveladi jandacvis sistemaSi

axalgazrdebis aqtiurad Cabmas pirveladi jandacvis sistemaSi rogorc

strategias maTTvis da mTeli sazogadoebisaTvis janmrTeli cxovrebis wesis
dasamkvidreblad dRes mTels msoflioSi didi yuradReba eTmoba. dRevandeli
msoflios mosaxleobis naxevarze meti 25 wlisaa. es uzarmazari potencialia
dasaxelebuli miznis gansaxorcieleblad. arsebobs kidev sxva mizezebi
imisaTvis, Tu ratom unda iyvnen axalgazrdebi aqtiurad Cabmulni
sazogadoebrivi jandacvis sistemaSi:
 axalgazrdebi yovelTvis exmarebodnen TavianT ojaxebsa da
sazogadoebas. maTi es tradiciuli roli amosavali punqtia jandacvis
samsaxurSi maT Casabmelad;
 zrunva ojaxisa da sazogadoebis keTildReobisaTvis, sxvis mimarT
daxmarebis gawevis gamocdilebis miReba, mozrdilTa gverdiT
muSaoba-pirovnuli zrdis Semadgeneli nawilebia;
 axalgazrdebSi xSirad keTilSobilni, gulRiani da gaxsnilni arian. maTi
enTuziazmi da sixaruli did impulss umateben im produqts, romlebSic
isini arian CarTulni;
 axalgazrdebi fizikurad, emociurad da inteleqtualurad mzad arian
reagirebisaTvis, zogierT SemTxvevaSi ufro metad, vidre mozrdilebi;
maT gaaCniaT xalisi, idealizmi, usazRvro energia.

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 imisaTvis, rom mozardebi efeqturad monawileoben janmrTelobis dacvis
samsaxurSi, rekomendirebulia:
 unda arsebobdes ormxrivi komunikacia imisaTvis, rom axalgazrdebs
SeeZloT sruli informaciis miReba da Tavisi ideebis ganxorcieleba;
 mozardebs unda gaaCndeT sityvis ufleba gadawyvetilebis miRebaSi
miznebis, politikis, aqtiurobis xasiaTis, resursebis moxmarebis
Sesaxeb yvela sakiTxSi, romelic maT janmrTelobas Seexeba;
 mozardebi CarTulni unda iyvnen dagegmvaSi, organizaciaSi da
SesrulebaSi yvela gamokvlevebisa jandacvis sferoSi.
 mTavrobam xeli unda Seuwyos mozardTa CarTvas maTi janmrTelobis
srulyofisa da dacvis saqmeSi, gansakuTrebiT iseT sferoebSi, rogoricaa
ojaxuri cxovreba, seqsualuri aRzrda, sarisko xasiaTis qmedebebisagan
Tavis acileba;
 mTavrobebma unda aRiaron, rom axalgazrdobis janmrTeloba
fundamenturi sakiTxia sayovelTao ganviTarebisaTvis da rom
axalgazrdebis monawileoba aucilebeli pirobaa jandacvis
ganviTarebasa da dacvisaTvis.

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